Abstract
Background Renal replacement therapy (RRT), as a cornerstone of supportive treatment, has long been performed in critically ill patients with acute kidney injury (AKI). However, the majority of studies may have neglected the effect of the duration of RRT on the outcome of AKI patients. This paper is aiming to explore the effect of the long duration of RRT on the outcome of critically ill patients with AKI. Methods This retrospective study was conducted by using the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) database. The primary outcome measure of this study was the mortality at 28 days, 60 days, and 90 days in the long-duration RRT group and the non-long-duration RRT group. The secondary outcomes assessed the difference in clinical outcome in these two groups. Lastly, the effect of the duration of RRT on mortality in AKI patients was determined as the third outcome. Results We selected 1,020 patients in total who received RRT according to the MIMIC-II database. According to the inclusion and exclusion criteria, we finally selected 506 patients with AKI: 286 AKI patients in the non-long-duration RRT group and 220 in the long-duration RRT group. After 28 days, there was a significant difference in all-cause mortality between the long-duration RRT group and the non-long-duration RRT group (P=0.001). However, the difference disappeared after 60 days and 90 days (P=0.803 and P=0.925, respectively). The length of ICU stay, length of hospital stay, and duration of mechanical ventilation were significantly longer in the long-duration RRT group than those in the non-long-duration RRT group. Considering 28-day mortality, the longer duration of RRT was shown to be a protective factor (HR = 0.995, 95% CI 0.993–0.997, P < 0.0001), while 60-day and 90-day mortality were not correlated with improved protection. Conclusions The long duration of RRT can improve the short-term prognosis of AKI patients, but it does not affect the long-term prognosis of these patients. Prognosis is determined by the severity of the illness itself. This suggests that RRT can protect AKI patients through the most critical time; however, the final outcome cannot be altered.
Highlights
Acute kidney injury (AKI), for which morbidity and mortality have increased continually, is a ubiquitous complication in patients admitted to the intensive care unit (ICU) [1]
Setting. is retrospective study was conducted by using the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) database, version 3.0. e MIMIC-II database is a publicly available clinical database developed by the Massachusetts Institute of Technology (MIT), Phillips Healthcare, and Beth Israel Deaconess Medical Center (BIDMC). is database contains data from more than 32,000 critically ill patients who were treated in the ICUs at BIDMC from 2001 to 2008
We selected all the patients treated with Renal replacement therapy (RRT) from the MIMIC-II database. e inclusion criteria for the present study were as follows: (1) aged ≥18 years; (2) admitted to the ICU for the first time; (3) received RRT; and (4) suffered from acute kidney injury (AKI). e exclusion criteria were as follows: (1) the duration of RRT was less than 24 hours or (2) the diagnosis included end-stage renal disease (ESRD) or chronic kidney disease (CKD) without AKI
Summary
Acute kidney injury (AKI), for which morbidity and mortality have increased continually, is a ubiquitous complication in patients admitted to the intensive care unit (ICU) [1]. Studies regarding the relationship between long-duration RRT and the outcome of critically ill patients are scarce. Long-duration RRT in adult AKI patients is correlated with higher mortality [11] In these reports, the time span of “long duration” is inconsistent, the duration of RRT is calculated ambiguously, and the sample sizes are relatively small, all of which may affect the accuracy of the results. Renal replacement therapy (RRT), as a cornerstone of supportive treatment, has long been performed in critically ill patients with acute kidney injury (AKI). Is paper is aiming to explore the effect of the long duration of RRT on the outcome of critically ill patients with AKI. E primary outcome measure of this study was the mortality at 28 days, 60 days, and 90 days in the long-duration RRT group and the non-long-duration RRT group. Prognosis is determined by the severity of the illness itself. is suggests that RRT can protect AKI patients through the most critical time; the final outcome cannot be altered
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