Is renal replacement therapy an independent predictor of long term mortality?

Kinsella, J., Shaw, M., Quasim, T. and McPeake, J. (2014) Is renal replacement therapy an independent predictor of long term mortality? Critical Care Medicine, 42(12), A1582. (doi:10.1097/01.ccm.0000458419.95176.52)

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Publisher's URL: http://dx.doi.org/10.1097/01.ccm.0000458419.95176.52

Abstract

Learning Objectives: Acute renal failure in the critically ill is associated with high mortality. Mortality may reflect the severity of the insult and other factors affecting outcome rather than being a consequence of renal failure. We wished to test the hypothesis that in a mixed cohort of critically ill patients the requirement for renal replacement therapy (RRT) is an independent predictor of mortality.<p></p> Methods: Data was collected prospectively in a cohort of patients admitted to a tertiary care general ICU. APACHE II, renal failure was defined according to AKIN criteria and the use of renal replacement therapy was automatically recorded in the clinical database.<p></p> Results: The index admission of 580 first time level three ICU patients were analysed during the 18 month cohort study. 93 (16%) patients required RRT during the study period with a median duration of RRT of 3 days (IQR, 1–7). ICU mortality was significantly different between those who did and did not receive RRT (48.4% vs. 20.7%, p<0.001). Hospital mortality was significantly different between those who did and did not receive RRT (60.2% vs. 26.7%, p<0.001). Mortality at six months in this entire cohort of patients was 37%. Six month outcome was significantly different between those who did and did not receive RRT (p<0.001). On unadjusted analysis, RRT was associated with an almost three fold increased odds of mortality at six months post ICU discharge (HR 2.87; CI 2.13–3.86, p< 0.001). After adjustment for the presence of septic shock during this ICU stay, age and APACHE II, RRT was independently associated with an increased odds of mortality at 6 months post ICU discharge (HR 1.62; CI 1.17–2.23, p<0.001).<p></p> Conclusions: The requirement for renal replacement therapy was in the mid range of the published literature. Renal replacement therapy is associated with high short term and 6 month mortality. Renal replacement therapy is an independent predictor of mortality after adjusting for septic shock and age. Further research is required to establish the reasons for the increased mortality at six months, particularly to identify any reversible causes.<p></p>

Item Type:Articles
Additional Information:44th Critical Care Congress, Society of Critical Care Medicine, Phoenix, AZ, USA, 17-21 January 2015
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Quasim, Dr Tara and Kinsella, Professor John and McPeake, Dr Joanne and Shaw, Mr Martin
Authors: Kinsella, J., Shaw, M., Quasim, T., and McPeake, J.
Subjects:R Medicine > R Medicine (General)
R Medicine > RT Nursing
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
Journal Name:Critical Care Medicine
Publisher:Lippincott, Williams and Wilkins
ISSN:0090-3493
ISSN (Online):1530-0293

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