Max Bell1, Fredrik Granath2, Staffan Schön3, Anders Ekbom2, Claes-Roland Martling4. 1. Department of Anaesthesiology and Intensive Care, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden. max.bell@karolinska.se. 2. Department of Medicine, Clinical Epidemiology Unit, Karolinska University Hospital, Solna, Sweden. 3. Swedish Register of Active Treatment of Uraemia, Department of Nephrology, Kärnhospital, Skövde, Sweden. 4. Department of Anaesthesiology and Intensive Care, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden.
Abstract
OBJECTIVE: Acute renal failure can be treated with continuous renal replacement therapy (CRRT) or intermittent haemodialysis (IHD). Whether this choice affects renal recovery has been debated, since it has implications on quality of life and costs. Our objective was to determine the impact of CRRT and IHD on renal recovery. DESIGN: Nationwide retrospective cohort study between the years 1995 and 2004. Follow-up ranged between 3 months and 10 years. SETTING: Thirty-two Swedish intensive care units. PATIENTS AND PARTICIPANTS: Eligible subjects were adults treated in Swedish general intensive care units with RRT. A total of 2,642 patients from 32 ICUs were included. We then excluded patients with end-stage renal disease (252) and patients lacking a diagnosis in the in-patient register (188). Thus, 2,202 patients were studied. Follow-up was complete. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The primary outcome was renal recovery. Secondarily we studied the mortality of the cohort. There were no differences between IHD and CRRT patients regarding baseline characteristics, such as age, sex and comorbidities. Of the 1,102 patients surviving 90 days after inclusion in the cohort, 944 (85.7%) were treated with CRRT and 158 (14.3%) were treated with IHD. Seventy-eight patients (8.3%; confidence interval, CI, 6.6-10.2), never recovered their renal function in the CRRT group. The proportion was significantly higher among IHD patients, where 26 subjects or 16.5% (CI 11.0-23.2) developed need for chronic dialysis. CONCLUSIONS: The use of CRRT is associated with better renal recovery than IHD, but mortality does not differ between the groups.
OBJECTIVE:Acute renal failure can be treated with continuous renal replacement therapy (CRRT) or intermittent haemodialysis (IHD). Whether this choice affects renal recovery has been debated, since it has implications on quality of life and costs. Our objective was to determine the impact of CRRT and IHD on renal recovery. DESIGN: Nationwide retrospective cohort study between the years 1995 and 2004. Follow-up ranged between 3 months and 10 years. SETTING: Thirty-two Swedish intensive care units. PATIENTS AND PARTICIPANTS: Eligible subjects were adults treated in Swedish general intensive care units with RRT. A total of 2,642 patients from 32 ICUs were included. We then excluded patients with end-stage renal disease (252) and patients lacking a diagnosis in the in-patient register (188). Thus, 2,202 patients were studied. Follow-up was complete. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The primary outcome was renal recovery. Secondarily we studied the mortality of the cohort. There were no differences between IHD and CRRT patients regarding baseline characteristics, such as age, sex and comorbidities. Of the 1,102 patients surviving 90 days after inclusion in the cohort, 944 (85.7%) were treated with CRRT and 158 (14.3%) were treated with IHD. Seventy-eight patients (8.3%; confidence interval, CI, 6.6-10.2), never recovered their renal function in the CRRT group. The proportion was significantly higher among IHD patients, where 26 subjects or 16.5% (CI 11.0-23.2) developed need for chronic dialysis. CONCLUSIONS: The use of CRRT is associated with better renal recovery than IHD, but mortality does not differ between the groups.
Authors: D N Churchill; G W Torrance; D W Taylor; C C Barnes; D Ludwin; A Shimizu; E K Smith Journal: Clin Invest Med Date: 1987-01 Impact factor: 0.825