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Abstract
Continuous renal replacement therapy (CRRT) is an important modality to support critically ill patients, and the need for CRRT treatment has been increasing. However, CRRT management is costly, and the associated resources are limited. Thus, it remains challenging to identify patients that are likely to have a poor outcome, despite active treatment with CRRT. We sought to elucidate the factors associated with early mortality after CRRT initiation. We analyzed 240 patients who initiated CRRT at an academic medical center between September 2016 and January 2018. We compared baseline characteristics between patients who died within seven days of initiating CRRT (early mortality), and those that survived more than seven days beyond the initiation of CRRT. Of the patients assessed, 130 (54.2%) died within seven days of CRRT initiation. Multivariate logistic regression models revealed that low mean arterial pressure, low arterial pH, and high Sequential Organ Failure Assessment score before CRRT initiation were significantly associated with increased early mortality in patients requiring CRRT. In conclusion, the mortality within seven days following CRRT initiation was very high in this study. We identified several factors that are associated with early mortality in patients undergoing CRRT, which may be useful in predicting early outcomes, despite active treatment with CRRT.
Highlights
Acute kidney injury (AKI) is a major complication in critically ill patients, and it is associated with high mortality [1,2,3]
This study demonstrated that early mortality within seven days following Continuous renal replacement therapy (CRRT) initiation was high in critically ill patients undergoing CRRT (54.2%)
Clinicians are often challenged to determine the benefit of CRRT, and it is difficult to identify patients that are more likely to demonstrate poor clinical outcomes, despite active treatment with CRRT to make the best decision for patients requiring renal replacement therapy (RRT)
Summary
Acute kidney injury (AKI) is a major complication in critically ill patients, and it is associated with high mortality [1,2,3]. Several factors, including sepsis, high acute physiology, and chronic health evaluation (APACHE) II score and/or sequential organ failure assessment (SOFA) score, poor urine output before CRRT initiation, comatose state, need for mechanical ventilation, fluid overload status, and type of CRRT solution are associated with increased mortality rate [16,17,18,19,20,21,22].
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