Early Mortality in Continuous Renal Replacement Therapy

New Orleans—In patients with acute kidney injury (AKI) who are hemodynamically unstable, the treatment modality of choice is continuous renal replacement therapy (CRRT). However, according to researchers, the mortality rate in AKI in intensive care units is high despite the use of CRRT.

Haewon Lee, MD, and colleagues in the Republic of Korea conducted a retrospective observational study designed to identify factors associated with an increased risk for 72-hour mortality in CRRT. They reported study results during a poster session at Kidney Week 2017 in a poster titled Risk Factors Associated with Early Mortality in Continuous Renal Replacement Therapy.

The study included 154 patients who received CRRT form March 2010 to December 2016. The researchers analyzed laboratory parameters, demographic characteristics, administration of vasopressors, use of ventilator, comorbidities, presence of anuria, and fluid overload to identify any association with mortality.

Among the 154 patients in the study, 89% (n=137) died in the ICU while on CRRT. There were significant differences between survivors and non-survivors in total bilirubin (1.61 vs 6.06 mg/dL; P=.01), mean blood pressure (77.7 vs 66.91 mmHg; P=.01), systolic blood pressure (108.53 vs 90.12 mmHg; P=.01), and amount of fluid overload for 3 days prior to initiation of CRRT (5.02 vs 8.21 L; P=.01).

Univariate analysis revealed parameters associated with mortality included use of ventilator (odds ratio [OR], 10.75; 95% confidence interval [CI], 0.031-0.283), vasopressors (OR, 4.16; 95% CI, 0.85-1.71), malignancies (OR, 4.76; 95% CI, 0.04-0.9), and pre-CRRT fluid overload more than 2.5L (OR, 3.91; 95% CI, 1.06-14.3). In Cox multivariate regression analysis, independent factors for death within 72 hours following CRRT initiation were use of vasopressors (hazard ratio [HR], 0.32; P=.01), malignancy (HR, 0.55; P=.02), and pre-CRRT fluid overload (HR, 0.63; P=.03).

“In conclusion, comorbidities such as malignancies, systolic blood pressure, and pre-CRRT fluid overload were closely related with 72-hour mortality in CRRT, which may require close attention during ICU care. We emphasize the need to identify clinical or laboratory factors, especially those that are correctable, in the management of critical acute kidney injury,” the authors said.

Source: Lee H, Kim YW, Park B, Park S, Park Sj, Lee Yj. Risk factors associated with early mortality in continuous renal replacement therapy. Abstract of a poster presented at the American Society of Nephrology 2017 Kidney Week, November 4, 2017, New Orleans, Louisiana.