Abstract
Objectives. Population-based studies regarding renal replacement therapy (RRT) used in critical care populations are useful to understand the trend and impact of medical care interventions. We describe the use of RRT and associated outcomes (mortality and length of intensive care stay) in a level 1 hospital. Design. A retrospective descriptive observational study. Patients. Critically ill patients admitted to the ICU from 1 January to 31 December 2018. Interventions. Age, gender, ward of admission, primary organ dysfunction at admission, length of hospital stay (LOS), mechanical ventilation, APACHE, SOFA and ISS scores, the use of vasopressors, transfusion, RRT and the number of RRT sessions were extracted. Results. 1703 critically ill patients were divided into two groups: the RRT-group (238 patients) and the non-RRT group (1465 patients). The mean age was 63.58 ± 17.52 (SD) in the final ICU studied patients (64.72 ± 16.64 SD in the RRT-group), 60.5% being male. Patients admitted from general surgery ward needing RRT were 41.4%. The specific scores, the use of vasopressors, transfusions and mortality were higher in the RRT-group. The ICU LOS was superior in the RRT-group, regardless of the primary organ dysfunction. Conclusions. RRT was practiced in 13.9% of patients (especially after age of 61), with mortality being the outcome for 66.8% of the RRT-group patients. All analyzed data were higher in the RRT group, especially for multiple trauma and surgical patients, or patients presenting cardiac or renal dysfunctions at admission. We found significant increased ISS scores in the RRT-group, a significant association between the need of vasopressors or transfusion requirement and RRT use, and an association in the number of RRT sessions and LOS (p < 0.001).
Highlights
None of the patients previously diagnosed with chronic kidney disease (CKD) and considered for this article were included in a chronic dialysis program
Epidemiological studies regarding the use of renal replacement therapy (RRT) in critically ill patients are scarce, and usually focused on population characterization according to acute kidney injury (AKI) presence and stage, main diagnosis/organ dysfunction, length of hospital stay (LOS) or mortality depending on the AKI stage
Modalities, RRT session length or the type of filters used. Those between 51 and 80 years of age, of male gender, from general surgery and internal medicine wards, and patients with gastrointestinal, respiratory, cardiac dysfunctions or having a postoperative state at intensive care unit (ICU) admission have a higher risk of needing CRRT during their ICU stay
Summary
Acute kidney injury (AKI) is a common complication of critically ill patients, being associated with grater morbidity and mortality rates, both at short and long terms, and this remains a constant health problem [1,2]. Half of all intensive care unit (ICU) patients will go through at least one episode of AKI during hospitalization [3]. Renal replacement therapy (RRT) is used to provide support for AKI or multiple organ dysfunction syndrome (MODS) [4,5]. Various reports have shown broad variability in estimating the use of RRT in ICU patients, from
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