Does Early Initiation of Continuous Renal Replacement Therapy Affect Outcome: Experience in a Tertiary Care Center

Abstract

Background: Acute kidney injury (AKI) requiring dialysis commonly occurs in critically ill patients and is associated with high mortality. Factors impacting outcomes of individuals with AKI who underwent continuous renal replacement therapy (CRRT), including early versus late initiation and duration of CRRT, were examined. Methods: Survival and recovery of renal function for patients with AKI in the intensive care unit were retrospectively examined over a 7-year period. Factors associated with mortality and renal recovery were analyzed based on severity of illness as defined by Cleveland Clinic Foundation (CCF) score. Univariate and multivariate logistic regression analysis with backward elimination was performed to determine the most significant risk factors. Results: Of patients who underwent CRRT, 230/330 met inclusion criteria. During index admission 112/230 (48.7%) patients died. Median survival was 15.5 days [95% confidence interval (12.0, 18.0)]. Among survivors, renal recovery occurred in 84/118 (71.2%). Renal recovery overall was observed in 90/230 subjects (39.13%). A higher baseline CCF score correlated with higher mortality and lower probability of renal recovery. Patients initiated on CRRT > 6 days after AKI diagnosis had significantly higher mortality compared with those initiated earlier (odds ratio = 11.66, p = 0.0305). Patients receiving CRRT >10 days had a higher mortality rate compared with those with shorter exposure (71.3% vs. 45.5%, respectively, p = 0.012). Conclusions: CRRT remains an important dialysis modality in hemodynamically unstable patients with AKI. Mortality in these patients continues to be high. Renal recovery is high in survivors. Delay in initiation and length of CRRT exposure may portend poorer prognosis.

Keywords:

• Acute kidney injury
• acute renal failure
• continuous renal replacement therapy
• dialysis

ACKNOWLEDGMENTS

The authors greatly appreciate the efforts of Ingrid Glurich, PhD, of the Marshfield Clinic Research Foundation’s Office of Scientific Writing and Publication in editing and critical review of the manuscript. The efforts of the Marshfield Clinic data abstraction team in performing such an extensive data abstraction are greatly appreciated. We also thank Jeanne Schreiner, RN, for providing us with all the information regarding the dialysis machines and the technical aspects of CRRT and Dr. Sevag Demirjian, Cleveland Clinic, for facilitating access to the original data for CCF score calculation and study by Augustine et al. Funding for this study was provided by the Marshfield Clinic, Physician Research Funds.

Declaration of interest: HSV, RAD, TRO, and HL are employees of Marshfield Clinic. Authors report no real or perceived conflict of interest.