Abstract
IntroductionPatients with severe acute kidney injury (AKI) who are hospitalized at centers that do not provide renal replacement therapy (RRT) are frequently subjected to inter-hospital transfer for the provision of RRT. It is unclear whether such transfers are associated with worse patient outcomes as compared with the receipt of initial care in a center that provides RRT. This study examined the relationship between inter-hospital transfer and 30-day mortality among critically ill patients with AKI who received RRT.MethodsWe conducted a retrospective cohort study of all critically ill patients who commenced RRT for AKI at two academic hospitals in Toronto, Canada. The exposure of interest was inter-hospital transfer for the administration of RRT. We evaluated the relationship between transfer status and 30-day mortality (primary outcome) and RRT dependence at 30 days following RRT initiation (secondary outcome), by using multivariate logistic regression with adjustment for patient demographics, clinical factors, biochemical indices, and severity of illness.ResultsOf 370 patients who underwent RRT for AKI, 82 (22.2%) were transferred for this purpose from another hospital. Compared with non-transferred patients who started RRT, transferred patients were younger (61 ± 15 versus 65 ± 15 years, P = 0.03) and had a higher serum creatinine concentration at RRT initiation (474 ± 295 versus 365 ± 169 μmol/L, P = 0.002). Inter-hospital transfer was not associated with mortality (adjusted odds ratio 0.61, 95% confidence interval 0.33 to 1.12) or RRT-dependence (adjusted odds ratio 1.64, 95% confidence interval 0.70 to 3.81) at 30 days.ConclusionsWithin the limitations of this observational study and the potential for residual confounding, inter-hospital transfer of critically ill patients with AKI was not associated with a higher risk of death or dialysis dependence 30 days after the initiation of acute RRT.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0513-1) contains supplementary material, which is available to authorized users.
Highlights
Patients with severe acute kidney injury (AKI) who are hospitalized at centers that do not provide renal replacement therapy (RRT) are frequently subjected to inter-hospital transfer for the provision of RRT
We hypothesized that patients who were initially admitted to a facility that did not provide RRT and were subsequently transferred to another hospital for the provision of RRT would have higher mortality and a higher risk of RRT dependence compared with individuals with RRT requiring AKI who commenced their hospitalization at centers with on-site RRT capability
To the best of our knowledge, this is the first study to examine the impact of inter-hospital transfer on clinical outcomes among critically ill patients with AKI who received RRT
Summary
Patients with severe acute kidney injury (AKI) who are hospitalized at centers that do not provide renal replacement therapy (RRT) are frequently subjected to inter-hospital transfer for the provision of RRT. It is unclear whether such transfers are associated with worse patient outcomes as compared with the receipt of initial care in a center that provides RRT. This study examined the relationship between inter-hospital transfer and 30-day mortality among critically ill patients with AKI who received RRT. We conducted a two-center retrospective cohort study to examine the relationship between inter-hospital transfer and 30-day mortality among critically ill patients with AKI who initiated RRT. We hypothesized that patients who were initially admitted to a facility that did not provide RRT and were subsequently transferred to another hospital for the provision of RRT would have higher mortality and a higher risk of RRT dependence compared with individuals with RRT requiring AKI who commenced their hospitalization at centers with on-site RRT capability
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