Short-term prognosis and influencing factors of patients with acute kidney injury treated with prolonged intermittent renal replacement therapy.

Abstract

Studies assessing prognosis after prolonged intermittent renal replacement therapy (PIRRT) for acute kidney injury (AKI) are scarce. To assess the impact of PIRRT on AKI and factors associated with short-term prognosis. In this retrospective nested case-control study, AKI patients administered PIRRT in Shanghai General Hospital from 01/2012 to 10/2018 were assigned to the 30-day survivor and death groups. Surviving patients were further divided into the kidney recovery and non-recovery groups at 30 and 90days post-discharge, respectively. Propensity score matching was performed. Totally 576 patients were included in the non-matched study population, mortality and kidney recovery rates were 51.7% and 33.4%, respectively. After propensity score matching, there were 250 patients in each of the death and survival groups. Low PIRRT frequency (OR=2.165, 95% CI=1.178-3.978), infection (OR=0.447, 95% CI=0.251-0.795), number of damaged vital organs (OR=0.478, 95% CI=0.346-0.661), sodium (OR=0.958, 95% CI=0.928-0.988), total protein (OR=1.047, 95% CI=1.022-1.072), pre-dialysis thrombin time (TT; OR=0.959, 95% CI=0.936-0.983), pre-discharge glomerular filtration rate (GFR; OR=1.024, 95% CI=1.017-1.031) and admission ward [reference: renal ward; intensive care unit (OR=0.042, 95% CI=0.008-0.211); surgery (OR=0.092, 95% CI=0.018-0.465); medical (OR=0.049, 95% C% CI=0.009-0.259); other (OR=0.097, 95% CI=0.016-0.572)] independently predicted 30-day mortality. Peripherally inserted central catheter (OR=13.970, 95% CI=1.439-135.589), urea nitrogen (OR=0.961, 95% CI=0.933-0.990) and pre-discharge GFR (OR=1.102, 95% CI=1.067-1.137) independently predicted 30-day kidney recovery. Pre-dialysis Scr (OR=0.997, 95% CI=0.995-0.999), urea nitrogen (OR=0.948, 95% CI=0.912-0.986) and pre-discharge GFR (OR=1.137 95% CI=1.088-1.189) independently predicted 90-day kidney recovery. PIRRT improves survival and kidney function recovery in AKI patients. In patients with previous GFR≥30mL/(min-1.73m2 ) and no prior maintenance dialysis, PIRRT at 3-5 sessions/week might be appropriate.