Renal Replacement Therapy in Patients with Influenza Pneumonia Related Acute Respiratory Distress Syndrome.

Ko-Wei Chang,Ying-Chun Chien,Shaw-Woei Leu,Chau-Chyun Sheu,Han-Chung Hu,Kuang-Yao Yang,Chieh-Liang Wu,Ming-Ju Tsai,Shih-Wei Lin,Shinn-Jye Liang,Wei-Chih Chen,Kuo-Chin Kao,Hao-Chien Wang,Wen-Feng Fang,Chung-Kan Peng,Ming-Cheng Chan,Yu-Mu Chen

doi:10.3390/jcm10091837

Abstract

Acute kidney injury (AKI) requiring renal replacement therapy (RRT) increases the mortality of acute respiratory distress syndrome (ARDS) patients. The aim of this study was to investigate the outcomes and predictors of RRT in patients with influenza pneumonia-related ARDS. This retrospective cohort study includes patients from eight tertiary referral centers in Taiwan between January and March 2016, and all 282 patients with influenza pneumonia-related ARDS were enrolled. Thirty-four patients suffered from AKI requiring RRT, while 16 patients had underlying end stage renal disease (ESRD). The 30- and 60-day mortality rates were significantly higher in patients with AKI requiring RRT compared with those not requiring RRT (50.0% vs. 19.8%, p value < 0.001; 58.8% vs. 27.2%, p value = 0.001, respectively), but the patients with ESRD had no significant difference in mortality (12.5% vs. 19.8%, p value = 0.744; 31.3% vs. 27.2%, p value = 0.773, respectively). The predictors for AKI requiring RRT included underlying chronic liver disease and C-reactive protein. The mortality predictors for patients with AKI requiring RRT included the pneumonia severity index, tidal volume, and continuous renal replacement therapy. In this study, patients with influenza pneumonia-related ARDS with AKI requiring RRT had significantly higher mortality compared with other patients.

Highlights

Acute kidney injury (AKI), defined by the Acute Kidney Injury Network [1], happened in 36–67% critically ill patients, and 5–6% of them need renal replacement therapy (RRT) [2].For the critically ill patients who suffer from AKI and need RRT, the mortality rate is as high as 60% [3]
A total of 336 patients were diagnosed with influenza and admitted to the ICU between
We found that patients with influenza pneumonia induced acute respiratory distress syndrome (ARDS)

Summary

Introduction

Acute kidney injury (AKI), defined by the Acute Kidney Injury Network [1], happened in 36–67% critically ill patients, and 5–6% of them need renal replacement therapy (RRT) [2]. For the critically ill patients who suffer from AKI and need RRT, the mortality rate is as high as 60% [3]. For patients with acute respiratory distress syndrome (ARDS), inadequate mechanical ventilator settings might contribute to adverse renal effects [4,5].A previous study showed that the incidence of AKI in patients with ARDS was 44.3% and the mortality rate was up to 42.3% [6]. Another study which investigated patients with prolonged mechanical ventilation revealed that the weaning and survival rates were lower in patients with RRT which started in the ICU compared with those with end stage renal disease (ESRD) [7].

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Discussion

Conclusion