Abstract
BackgroundData on renal replacement therapy (RRT) in cancer patients with acute kidney injury (AKI) in the intensive care unit (ICU) is scarce. The aim of this study was to assess the safety and the adequacy of intermittent hemodialysis (IHD) in critically ill cancer patients with AKI.Methods and FindingsIn this observational prospective cohort study, 149 ICU cancer patients with AKI were treated with 448 single-pass batch IHD procedures and evaluated from June 2010 to June 2012. Primary outcomes were IHD complications (hypotension and clotting) and adequacy. A multiple logistic regression was performed in order to identify factors associated with IHD complications (hypotension and clotting). Patients were 62.2 ± 14.3 years old, 86.6% had a solid cancer, sepsis was the main AKI cause (51%) and in-hospital mortality was 59.7%. RRT session time was 240 (180–300) min, blood/dialysate flow was 250 (200–300) mL/min and UF was 1000 (0–2000) ml. Hypotension occurred in 25% of the sessions. Independent risk factors (RF) for hypotension were dialysate conductivity (each ms/cm, OR 0.81, CI 0.69–0.95), initial mean arterial pressure (each 10 mmHg, OR 0.49, CI 0.40–0.61) and SOFA score (OR 1.16, CI 1.03–1.30). Clotting and malfunctioning catheters (MC) occurred in 23.8% and 29.2% of the procedures, respectively. Independent RF for clotting were heparin use (OR 0.57, CI 0.33–0.99), MC (OR 3.59, CI 2.24–5.77) and RRT system pressure increase over 25% (OR 2.15, CI 1.61–4.17). Post RRT blood tests were urea 71 (49–104) mg/dL, creatinine 2.71 (2.10–3.8) mg/dL, bicarbonate 24.1 (22.5–25.5) mEq/L and K 3.8 (3.5–4.1) mEq/L.ConclusionIHD for critically ill patients with cancer and AKI offered acceptable hemodynamic stability and provided adequate metabolic control.
Highlights
An increasing number of patients with cancer have been admitted to intensive care units (ICU) worldwide, accounting for up to 15% of all ICU admissions [1, 2]
The survival of these patients has increased in the last decades [3,4,5,6] and approximately up to 49% of them experience an episode of acute kidney injury (AKI) during the ICU stay; 9% to 32% of them require renal replacement (RRT) [7,8,9]
This is a prospective cohort of critically ill cancer patients with AKI who were treated with RRT in the ICU at the Instituto do Câncer do Estado de São (ICESP), Faculdade de Medicina da Universidade de São Paulo, a tertiary academic hospital in Brazil, exclusively devoted to the care of cancer patients
Summary
An increasing number of patients with cancer have been admitted to intensive care units (ICU) worldwide, accounting for up to 15% of all ICU admissions [1, 2] The survival of these patients has increased in the last decades [3,4,5,6] and approximately up to 49% of them experience an episode of acute kidney injury (AKI) during the ICU stay; 9% to 32% of them require renal replacement (RRT) [7,8,9]. Data on renal replacement therapy (RRT) in cancer patients with acute kidney injury (AKI) in the intensive care unit (ICU) is scarce. The aim of this study was to assess the safety and the adequacy of intermittent hemodialysis (IHD) in critically ill cancer patients with AKI
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