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Intensive Care Medicine

, Volume 42, Issue 9, pp 1408–1417 | Cite as

Continuous renal replacement therapy versus intermittent hemodialysis in intensive care patients: impact on mortality and renal recovery

  • Anne-Sophie Truche
  • Michael Darmon
  • Sébastien Bailly
  • Christophe Clec’h
  • Claire Dupuis
  • Benoit Misset
  • Elie Azoulay
  • Carole Schwebel
  • Lila Bouadma
  • Hatem Kallel
  • Christophe Adrie
  • Anne-Sylvie Dumenil
  • Laurent Argaud
  • Guillaume Marcotte
  • Samir Jamali
  • Philippe Zaoui
  • Virginie Laurent
  • Dany Goldgran-Toledano
  • Romain Sonneville
  • Bertrand Souweine
  • Jean-Francois TimsitEmail author
  • OUTCOMEREA Study Group
Original

Abstract

Purpose

The best renal replacement therapy (RRT) modality remains controversial. We compared mortality and short- and long-term renal recovery between patients treated with continuous RRT and intermittent hemodialysis.

Methods

Patients of the prospective observational multicenter cohort database OUTCOMEREA™ were included if they underwent at least one RRT session between 2004 and 2014. Differences in patients’ baseline and daily characteristics between treatment groups were taken into account by using a marginal structural Cox model, allowing one to substantially reduce the bias resulting from confounding factors in observational longitudinal data analysis. The composite primary endpoint was 30-day mortality and dialysis dependency.

Results

Among 1360 included patients with RRT, 544 (40.0 %) and 816 (60.0 %) were initially treated by continuous RRT and intermittent hemodialysis, respectively. At day 30, 39.6 % patients were dead. Among survivors, 23.8 % still required RRT. There was no difference between groups for the primary endpoint in global population (HR 1.00, 95 % CI 0.77–1.29; p = 0.97). In patients with higher weight gain at RRT initiation, mortality and dialysis dependency were significantly lower with continuous RRT (HR 0.54, 95 % CI 0.29–0.99; p = 0.05). Conversely, this technique appeared to be deleterious in patients without shock (HR 2.24, 95 % CI 1.24–4.04; p = 0.01). Six-month mortality and persistent renal dysfunction were not influenced by the RRT modality in patients with dialysis dependence at ICU discharge.

Conclusion

Continuous RRT did not appear to improve 30-day and 6-month patient outcomes. It seems beneficial for patients with fluid overload, but might be deleterious in the absence of hemodynamic failure.

Keywords

Renal replacement therapy Acute kidney injury Intensive care unit Marginal structural model 

Notes

Acknowledgments

The authors thank Celine Feger, M.D. (EMIBiotech), for her editorial support.

Members of the Outcomerea Study Group

Scientific Committee: Jean-François Timsit (Medical and Infectious Diseases ICU, Bichat-Claude Bernard Hospital, Paris, France; UMR 1137 Inserm–Paris Diderot University IAME, F75018, Paris); Elie Azoulay (Medical ICU, Saint Louis Hospital, Paris, France); Maïté Garrouste-Orgeas (ICU, Saint-Joseph Hospital, Paris, France); Jean-Ralph Zahar (Infection Control Unit, Angers Hospital, Angers, France); Christophe Adrie (ICU, Delafontaine Hospital, Saint Denis, and Physiology, Cochin Hospital, Paris, France); Michael Darmon (Medical ICU, Saint Etienne University Hospital, St Etienne, France); and Christophe Clec’h (ICU, Avicenne Hospital, Bobigny, and UMR 1137 Inserm–Paris Diderot university IAME, F75018, Paris, France).

Biostatistical and Information System Expertise: Jean-Francois Timsit (Medical and Infectious Diseases ICU, Bichat-Claude Bernard Hospital, Paris, France; UMR 1137 Inserm–Paris Diderot university IAME, F75018, Paris); Corinne Alberti (Medical Computer Sciences and Biostatistics Department, Robert Debré Hospital, Paris, France); Adrien Français (Integrated Research Center U823, Grenoble, France); Aurélien Vesin (OUTCOMEREA organization and Integrated Research Center U823, Grenoble, France); Stephane Ruckly (OUTCOMEREA organization and Inserm UMR 1137 IAME, F75018, Paris); Sébastien Bailly (Grenoble University Hospital Inserm UMR 1137 IAME, F75018, Paris) and Christophe Clec’h (ICU, Avicenne Hospital, Bobigny, and Inserm UMR 1137 IAME, F75018, Paris, France); Frederik Lecorre (Supelec, France); Didier Nakache (Conservatoire National des Arts et Métiers, Paris, France); and Aurélien Vannieuwenhuyze (Tourcoing, France).

Investigators of the OUTCOMEREA Database: Christophe Adrie (ICU, Delafontaine Hospital, Saint Denis, and Physiology, Cochin Hospital, Paris, France); Bernard Allaouchiche (ICU, Pierre Benite Hospital, Lyon, France); Laurent Argaud (Medical ICU, Hospices Civils de Lyon, Lyon, France); Claire Ara-Somohano (Medical ICU, University Hospital, Grenoble, France); Elie Azoulay (Medical ICU, Saint Louis Hospital, Paris, France); Francois Barbier (medical-surgical ICU, Orleans, France), Jean-Pierre Bedos (ICU, Versailles Hospital, Versailles, France); Julien Bohé (ICU, Hôpital Pierre Benite, Lyon France), Lila Bouadma (ICU, Bichat Hospital, Paris, France); Christine Cheval (ICU, Hyeres Hospital, Hyeres, France); Christophe Clec’h (ICU, Avicenne Hospital, Bobigny, France); Michael Darmon (ICU, Saint Etienne Hospital, Saint Etienne, France); Anne-Sylvie Dumenil (Antoine Béclère Hospital, Clamart, France); Claire Dupuis (Bichat hospital and UMR 1137 Inserm–Paris Diderot University IAME, F75018, Paris, France), Marc Gainier hôpital la Timone, Marseille, France), Akim Haouache (Surgical ICU, H Mondor Hospital, Creteil, France); Samir Jamali (ICU, Dourdan, Dourdan Hospital, Dourdan, France); Hatem Khallel (ICU, Cayenne General Hospital, Cayenne, France); Alexandre Lautrette (ICU, G Montpied Hospital, Clermont-Ferrand, France); Guillaume Marcotte (Surgical ICU, Hospices Civils de Lyon, Lyon, France); Eric Le Miere (ICU, Louis Mourier Hospital, Colombes, France); Maxime Lugosi (Medical ICU, University Hospital Grenoble, Grenoble, France); Bruno Mourvillier (ICU, Bichat Hospital, Paris, France); Benoît Misset (ICU, Saint-Joseph Hospital, Paris, France); Delphine Moreau (ICU, Saint-Louis Hospital, Paris, France); Bruno Mourvillier (ICU, Bichat Hospital, Paris, France); Laurent Papazian (Hopital Nord, Marseille, France), Benjamin Planquette (pulmonology ICU, George Pompidou Hospital, Versailles, France); Bertrand Souweine (ICU, G Montpied Hospital, Clermont-Ferrand, France); Carole Schwebel (ICU, A Michallon Hospital, Grenoble, France); Gilles Troché (ICU, Antoine Béclère Hospital, Clamart, France); Marie Thuong (ICU, Delafontaine Hospital, Saint Denis, France); Guillaume Thierry (ICU, Saint-Louis Hospital, Paris, France); Dany Toledano (ICU, Gonesse Hospital, Gonesse, France); and Eric Vantalon (SICU, Saint-Joseph Hospital, Paris, France).

Study Monitors: Julien Fournier, Caroline Tournegros, Stéphanie Bagur, Mireille Adda, Vanessa Vindrieux, Loic Ferrand, Nadira Kaddour, Boris Berthe, Samir Bekkhouche, Kaouttar Mellouk, Sylvie Conrozier, Igor Theodose, Veronique Deiler, and Sophie Letrou.

Compliance with ethical standards

Funding

The study was entirely funded by the OUTCOMEREA research network. AST received an educational grant from the French Kidney Foundation under the aegis of the French Medical Research Foundation; code DEA2014FDR/FRM04_FdR-SdN-SFD_FRM_TRUCHE.

Conflicts of interest

The authors declare that they have no conflict of interest.

Supplementary material

134_2016_4404_MOESM1_ESM.docx (1.4 mb)
Supplementary material 1 (DOCX 1387 kb)
134_2016_4404_MOESM2_ESM.docx (20 kb)
Supplementary material 2 (DOCX 20 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  • Anne-Sophie Truche
    • 1
    • 2
    • 3
  • Michael Darmon
    • 4
    • 5
  • Sébastien Bailly
    • 1
    • 6
  • Christophe Clec’h
    • 1
    • 7
    • 8
  • Claire Dupuis
    • 1
    • 9
  • Benoit Misset
    • 10
    • 11
  • Elie Azoulay
    • 12
    • 13
  • Carole Schwebel
    • 2
  • Lila Bouadma
    • 9
  • Hatem Kallel
    • 14
  • Christophe Adrie
    • 15
  • Anne-Sylvie Dumenil
    • 16
  • Laurent Argaud
    • 17
  • Guillaume Marcotte
    • 18
  • Samir Jamali
    • 19
  • Philippe Zaoui
    • 3
  • Virginie Laurent
    • 20
  • Dany Goldgran-Toledano
    • 21
  • Romain Sonneville
    • 9
  • Bertrand Souweine
    • 22
  • Jean-Francois Timsit
    • 1
    • 9
    • 23
    Email author
  • OUTCOMEREA Study Group
    • 1
  1. 1.UMR 1137, IAME Team 5, DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Sorbonne Paris CitéInserm/Paris Diderot UniversityParisFrance
  2. 2.Medical Intensive Care UnitGrenoble University Hospital, Grenoble 1 UniversityLa TroncheFrance
  3. 3.NephrologyGrenoble University HospitalLa TroncheFrance
  4. 4.Medical Intensive Care UnitSaint Etienne University HospitalSaint-EtienneFrance
  5. 5.Jacques Lisfranc Medicine University, Jean Monnet UniversitySaint-EtienneFrance
  6. 6.Grenoble Alpes UniversityLa TroncheFrance
  7. 7.Intensive Care UnitAP-HP, Avicenne HospitalParisFrance
  8. 8.Medicine University, Paris 13 UniversityBobignyFrance
  9. 9.AP-HP, Bichat Hospital, Medical and Infectious Diseases Intensive Care UnitParis Diderot UniversityParisFrance
  10. 10.Intensive Care UnitSaint Joseph Hospital NetworkParisFrance
  11. 11.Sorbonne CiteMedicine University, Paris Descartes UniversityParisFrance
  12. 12.Medical Intensive Care UnitAP-HP, Saint Louis HospitalParisFrance
  13. 13.Medicine University, Paris 5 UniversityParisFrance
  14. 14.Medical Surgical ICU, Centre Hospitalier de CayenneGuyaneFrance
  15. 15.Physiology Department, Cochin University Hospital, Assistance Publique Des Hôpitaux de Paris (AP-HP)Paris Descartes UniversityParisFrance
  16. 16.AP-HP, Antoine Béclère University Hospital, Medical-surgical Intensive Care UnitClamartFrance
  17. 17.Medical Intensive Care UnitLyon University HospitalLyonFrance
  18. 18.Surgical ICUEdouard Herriot University HospitalLyonFrance
  19. 19.Critical Care Medicine Unit Dourdan HospitalDourdanFrance
  20. 20.Medical Intensive Care UnitAndré Mignot HospitalVersaillesFrance
  21. 21.Intensive Care UnitGonesse HospitalGonesseFrance
  22. 22.Medical Intensive Care UnitGabriel Montpied University HospitalClermont-FerrandFrance
  23. 23.Université Paris Diderot/Hôpital Bichat, Réanimation Medicale et des maladies infectieusesParisFrance

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