PURPOSE: To evaluate the characteristics and outcomes of critically ill patients with severe acute kidney injury (AKI) treated and not treated with renal replacement therapy (RRT). METHODS: Secondary analysis of a multi-centre cohort study. Primary exposure was RRT. Primary outcome was propensity and multi-variable adjusted-hospital mortality. RESULTS: We studied 1250 patients (71.3%) who received and 502 (28.7%) who did not receive RRT. Reasons for not starting RRT (not mutually exclusive) were limitations of support (33.6%, n = 169), adequate urine output (46.2%; n = 232), plan to observe (56.4%; n = 283), and advanced age (12.6%; n = 63). Mortality was higher in those not receiving RRT due to limitations and advanced age but lower for adequate urine output and plan to observe. Propensity and multi-variable adjusted analysis showed no statistical difference in hospital mortality (adj-OR 1.47; 95% CI, 0.93-2.24) in patients receiving RRT. Results were similar in a sensitivity analysis restricted to patients fulfilling risk, injury, failure, loss, end-stage kidney disease-FAILURE criteria (37.0%; n = 446) (adj-OR 1.36; 95% CI, 0.70-2.66). CONCLUSION: In this cohort, reasons for not starting RRT included limitations of support and perception of impending renal recovery. Despite similar risk of mortality after adjusting for selection bias and confounders, RRT-treated patients were fundamentally different from non-treated patients across a spectrum of variables that precludes valid comparison in observational data.
PURPOSE: To evaluate the characteristics and outcomes of critically illpatients with severe acute kidney injury (AKI) treated and not treated with renal replacement therapy (RRT). METHODS: Secondary analysis of a multi-centre cohort study. Primary exposure was RRT. Primary outcome was propensity and multi-variable adjusted-hospital mortality. RESULTS: We studied 1250 patients (71.3%) who received and 502 (28.7%) who did not receive RRT. Reasons for not starting RRT (not mutually exclusive) were limitations of support (33.6%, n = 169), adequate urine output (46.2%; n = 232), plan to observe (56.4%; n = 283), and advanced age (12.6%; n = 63). Mortality was higher in those not receiving RRT due to limitations and advanced age but lower for adequate urine output and plan to observe. Propensity and multi-variable adjusted analysis showed no statistical difference in hospital mortality (adj-OR 1.47; 95% CI, 0.93-2.24) in patients receiving RRT. Results were similar in a sensitivity analysis restricted to patients fulfilling risk, injury, failure, loss, end-stage kidney disease-FAILURE criteria (37.0%; n = 446) (adj-OR 1.36; 95% CI, 0.70-2.66). CONCLUSION: In this cohort, reasons for not starting RRT included limitations of support and perception of impending renal recovery. Despite similar risk of mortality after adjusting for selection bias and confounders, RRT-treated patients were fundamentally different from non-treated patients across a spectrum of variables that precludes valid comparison in observational data.
Authors: Sean M Bagshaw; Neill K J Adhikari; Karen E A Burns; Jan O Friedrich; Josée Bouchard; Francois Lamontagne; Lauralyn A McIntrye; Jean-François Cailhier; Peter Dodek; Henry T Stelfox; Margaret Herridge; Stephen Lapinsky; John Muscedere; James Barton; Donald Griesdale; Mark Soth; Althea Ambosta; Gerald Lebovic; Ron Wald Journal: Clin J Am Soc Nephrol Date: 2019-03-21 Impact factor: 8.237
Authors: Thomas S Valley; Brahmajee K Nallamothu; Michael Heung; Theodore J Iwashyna; Colin R Cooke Journal: Crit Care Med Date: 2018-02 Impact factor: 7.598
Authors: Gordon S Doig; Fiona Simpson; Rinaldo Bellomo; Philippa T Heighes; Elizabeth A Sweetman; Douglas Chesher; Carol Pollock; Andrew Davies; John Botha; Peter Harrigan; Michael C Reade Journal: Intensive Care Med Date: 2015-04-30 Impact factor: 17.440