OUTCOMES OF SEPTIC PATIENTS REQUIRING RENAL REPLACEMENT THERAPY: A SINGLE CENTER ANALYSIS

Abstract

SESSION TITLE: Critical Care Sepsis SESSION TYPE: Original Investigations PRESENTED ON: 10/07/2018 07:30 AM - 08:30 AM PURPOSE: The prevalence of acute kidney injury (AKI) - defined as an increase of serum creatinine of at least 1.5-1.9 times the baseline or an increase of at least 0.3 mg/dL from baseline - among critically ill patients is approximately 40-57%. Due to advancements in treatment strategies, renal replacement therapy (RRT) is becoming a common element of the intensive care setting, with about 13% of patients with AKI in the intensive care unit receiving RRT during their treatment course. Several studies have demonstrated that AKI in non-selected critically ill patients is associated with high mortality rates (some report as high as 80%), as well as other complications including development of end stage renal disease (ESRD) requiring long term dialysis. We sought to explore outcomes specifically of septic patients with AKI requiring new renal replacement therapy in our inner-city university hospital. METHODS: A retrospective chart analysis was performed of patients with a diagnosis of sepsis and/or septic shock who were treated with at least one form of RRT during the time period of 1/2009 – 5/2017 at Hahnemann University Hospital in Philadelphia, PA. We included adults (at least 18 yrs of age) who required new initiation of RRT. Exclusion criteria included any patient who had received RRT previously, patients with history of renal transplant and those with other reasons for renal injury other than sepsis. A total of 100 subjects were included in the study. We examined multiple data points including demographics, type of RRT, acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores. The outcomes we observed for included length of RRT, length of hospital stay, renal recovery and 5, 30, 60 and 90-day mortality rates. RESULTS: Average APACHE II and SOFA scores among the entire cohort were 22.2 and 10.2, respectively. 76% of subjects received continuous RRT only, 9% of subjects received intermittent hemodialysis only, and 15% received a combination of both. Overall survival rate among all included subjects at 90 days was 23%. 5-day mortality rate was 11%, 30-day mortality rate was 58%, 60-day mortality rate was 72% and total 90-day mortality rate was 77%. Of the mortalities, 1 subject (1.2%) recovered renal function and was removed from renal replacement therapy prior to death. Of the surviving subjects, 74% (17/23) had renal recovery with 6 subjects (26%) requiring long term dialysis upon conclusion of their hospital course. CONCLUSIONS: Sepsis and septic shock with AKI requiring new RRT is associated with significant mortality rates. In surviving patients, renal recovery is possible as only a minority of survivors developed end stage renal disease. CLINICAL IMPLICATIONS: Our results coincide with the current paradigm that AKI requiring RRT in critically ill patients is a significant prognostic indicator associated with poor outcomes. DISCLOSURES: No relevant relationships by Willis Ko, source=Web Response No relevant relationships by Ciro Rincon-Prieto, source=Web Response No relevant relationships by Michael Stephen, source=Web Response No relevant relationships by John Woytanowski, source=Web Response