Dataset Information

The effect of timing of initiation of renal replacement therapy on mortality: A retrospective case-control study.

ABSTRACT:

Purpose

To determine if earlier initiation of renal replacement therapy (RRT) is associated with improved survival in patients with severe acute kidney injury.

Methods

We performed a retrospective case-control study of propensity-matched groups with multivariable logistic regression using Akaike Information Criteria to adjust for non-matched variables in a surgical ICU in a tertiary care hospital.

Results

We matched 169 of 205 (82%) patients with new initiation of RRT (EARLY group) to 169 similar patients who did not initiate RRT on that day (DEFERRED group). Eighteen (11%) of DEFERRED eventually received RRT before discharge. By univariate analysis, ICU mortality was higher in EARLY (n?=?60 (36%) vs. n?=?23 (14%), p?p?=?0.001). Of the 18 RRT patients in DEFERRED, 12 (67%) died in ICU and 13 (72%) in hospital. After propensity matching and logistic regression, we found that EARLY initiation of RRT was associated with a more than doubling of ICU mortality (aOR?=?2.310, 95% confidence interval?=?1.254-4.257, p?=?0.007). However, after similar adjustment, there was no difference in hospital mortality (aOR?=?1.283, 95% CI?=?0.753-2.186, p?=?0.360).

Conclusions

While ICU mortality was increased in the EARLY group, there was no difference in hospital mortality between EARLY and DEFERRED groups.

SUBMITTER: Engoren M

PROVIDER: S-EPMC7890751 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

The effect of timing of initiation of renal replacement therapy on mortality: A retrospective case-control study.

Engoren Milo M Maile Michael D MD Heung Michael M Blum James M JM Blank Ross R Napolitano Lena M LM Park Pauline K PK Raghavendran Krishnan K Jewell Elizabeth S ES Meldrum Craig C

Journal of the Intensive Care Society 20191205 1

<h4>Purpose</h4>To determine if earlier initiation of renal replacement therapy (RRT) is associated with improved survival in patients with severe acute kidney injury.<h4>Methods</h4>We performed a retrospective case-control study of propensity-matched groups with multivariable logistic regression using Akaike Information Criteria to adjust for non-matched variables in a surgical ICU in a tertiary care hospital.<h4>Results</h4>We matched 169 of 205 (82%) patients with new initiation of RRT (EARL ...[more]

PMID: 33643427

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Project description:BackgroundPostoperative acute kidney injury (AKI) is associated with poor outcomes in surgical patients. This study aims to evaluate whether the timing of renal replacement therapy (RRT) initiation affects the in-hospital mortality of patients with postoperative AKI.MethodologyThis multicenter retrospective observational study, which was conducted in the intensive care units (ICUs) in a tertiary hospital (National Taiwan University Hospital) and its branch hospitals in Taiwan between January, 2002, and April, 2009, included adult patients with postoperative AKI who underwent RRT for predefined indications. The demographic data, comorbid diseases, types of surgery and RRT, and the indications for RRT were documented. Patients were categorized according to the period of time between the ICU admission and RRT initiation as the early (EG, ?1 day), intermediate (IG, 2-3 days), and late (LG, ?4 days) groups. The in-hospital mortality rate censored at 180 day was defined as the endpoint.ResultsSix hundred forty-eight patients (418 men, mean age 63.0±15.9 years) were enrolled, and 379 patients (58.5%) died during the hospitalization. Both the estimated probability of death and the in-hospital mortality rates of the three groups represented U-curves. According to the Cox proportional hazard method, LG (hazard ratio, 1.527; 95% confidence interval, 1.152-2.024; P?=?0.003, compared with IG group), age (1.014; 1.006-1.021), diabetes (1.279; 1.022-1.601; P?=?0.031), cirrhosis (2.147; 1.421-3.242), extracorporeal membrane oxygenation support (1.811; 1.391-2.359), initial neurological dysfunction (1.448; 1.107-1.894; P?=?0.007), pre-RRT mean arterial pressure (0.988; 0.981-0.995), inotropic equivalent (1.006; 1.001-1.012; P?=?0.013), APACHE II scores (1.055; 1.037-1.073), and sepsis (1.939; 1.536-2.449) were independent predictors of the in-hospital mortality (All P<0.001 except otherwise stated).ConclusionsThe current study found a U-curve association between the timing of the RRT initiation after the ICU admission and patients' in-hospital mortalities, and alerts physicians of certain factors affecting the outcome after the RRT initiation.

Project description:Background: Renal replacement therapy (RRT) was often needed by some severe burn patients with acute kidney injury (AKI). The primary aim of this study was to review incidence rate and mortality of RRT in severe burn patients. Second aims were to review RRT complications and renal outcome. Methods: We searched multiple databases for studies published between 1 January 1960 and 31 December 2019. Studies about adult populations with burn injury, providing epidemiologic data on prevalence or mortality of RRT, were included. Results: A total of selected 57 studies, including 27,437 patients were enrolled in our analysis. The prevalence rates of RRT were 8.34% (95% CI 7.18-9.5%) in all burn patients and 37.05% (95% CI 29.85-44.24%) in AKI patients. The mortality of all burn patients with RRT was 65.52% (95% CI 58.41-72.64%). The prevalence rates of RRT in sample size≥100 group were 6.86% (95% CI 5.70-8.03%), which was lower than that of <100 group (17.61%, 95% CI 13.39-21.82%). With the increase of TBSA, the prevalence of RRT may have the increasing trend. The prevalence rates of RRT in Asian group was 12.75% (95% CI 9.50-16.00%), which was higher than that of European (10.45%, 95% CI 7.30-13.61%) and North America group (5.61%, 95% CI 4.27-6.95%). The prevalence rates of RRT in 2010-2019 group was 12.22% (95% CI 10.09-14.35%), which was higher than that of 2009-2000 group (5.17%, 95% CI 2.88-7.46%). The prevalence rates of RRT in 1989 and before group was the lowest, which was 1.56% (95% CI 0-3.68%). However, there was no significant correlation between the year of publication and the mortality of burn patients with RRT. Dialysis-requiring AKI in burn patients could increases the risk of chronic kidney disease progression and end-stage renal disease. About 35% of RRT patients need to maintain haemodialysis temporarily, even if they survive and leave hospital. Conclusions: The prevalence rate of RRT is about 6-8%; approximately, one-third of burn patients with AKI need RRT. The prevalence rate of RRT increased over time, but the mortality did not change. The prevalence rates of RRT in Asian group was higher than that of European and North America group.

Dataset Information

The effect of timing of initiation of renal replacement therapy on mortality: A retrospective case-control study.

Purpose

Methods

Results

Conclusions

Publications

The effect of timing of initiation of renal replacement therapy on mortality: A retrospective case-control study.

Similar Datasets

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