Suvi T Vaara1, Matti Reinikainen2, Ron Wald3, Sean M Bagshaw4, Ville Pettilä5. 1. Intensive Care Units, Division of Anaesthesia and Intensive Care Medicine, Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland; suvi.vaara@helsinki.fi. 2. Department of Intensive Care, North Karelia Central Hospital, Joensuu, Finland; 3. Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada; 4. Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; and. 5. Intensive Care Units, Division of Anaesthesia and Intensive Care Medicine, Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland; Department of Clinical Sciences, University of Helsinki, Helsinki, Finland.
Abstract
BACKGROUND AND OBJECTIVES: No data on the development of conventional indications for RRT (refractory acidosis, hyperkalemia, uremia, oliguria/anuria, and volume overload) related to timing of RRT exist. The prevalence of conventional indications among critically ill patients on RRT for AKI was evaluated, and patients manifesting indications versus patients without indications were compared in terms of crude and adjusted 90-day mortality. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this substudy of the Finnish Acute Kidney Injury study conducted in 2011 and 2012 in 17 intensive care units with 2901 patients, patients were classified as pre-emptive (no conventional indications) and classic (one or more indications) RRT recipients. Patients with classic RRT were divided into classic-urgent (RRT initiated ≤ 12 hours from manifesting indications) and classic-delayed (RRT >12 hours from first indication). Additionally, 2450 patients treated without RRT were matched to patients with pre-emptive RRT. RESULTS: Of 239 patients treated with RRT, 134 (56.1%; 95% confidence interval [95% CI], 49.8% to 62.4%) fulfilled at least one conventional indication before commencing RRT. Crude 90-day mortality of 134 patients with classic RRT was 48.5% (95% CI, 40.0% to 57.0%), and it was 29.5% (95% CI, 20.8% to 38.2%) for the 105 patients with pre-emptive RRT. Classic RRT was associated with a higher risk for mortality (adjusted odds ratio, 2.05; 95% CI, 1.03 to 4.09). Forty-four patients with classic-delayed RRT showed higher crude mortality (68.2%; 95% CI, 54.4% to 82.0%) compared with patients with classic-urgent RRT, and this association persisted after adjustment for known confounders (odds ratio, 3.85; 95% CI, 1.48 to 10.22). Crude 90-day mortality of 67 1:1 matched patients with pre-emptive RRT was 26.9% (95% CI, 6.3% to 37.5%), and it was 49.3% (95% CI, 37.3% to 61.2%; P=0.01) for their non-RRT matches. CONCLUSIONS: Patients on RRT after one or more conventional indications had both higher crude and adjusted 90-day mortality compared with patients without conventional indications. These findings require confirmation in an adequately powered, multicenter, randomized controlled trial.
BACKGROUND AND OBJECTIVES: No data on the development of conventional indications for RRT (refractory acidosis, hyperkalemia, uremia, oliguria/anuria, and volume overload) related to timing of RRT exist. The prevalence of conventional indications among critically ill patients on RRT for AKI was evaluated, and patients manifesting indications versus patients without indications were compared in terms of crude and adjusted 90-day mortality. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this substudy of the Finnish Acute Kidney Injury study conducted in 2011 and 2012 in 17 intensive care units with 2901 patients, patients were classified as pre-emptive (no conventional indications) and classic (one or more indications) RRT recipients. Patients with classic RRT were divided into classic-urgent (RRT initiated ≤ 12 hours from manifesting indications) and classic-delayed (RRT >12 hours from first indication). Additionally, 2450 patients treated without RRT were matched to patients with pre-emptive RRT. RESULTS: Of 239 patients treated with RRT, 134 (56.1%; 95% confidence interval [95% CI], 49.8% to 62.4%) fulfilled at least one conventional indication before commencing RRT. Crude 90-day mortality of 134 patients with classic RRT was 48.5% (95% CI, 40.0% to 57.0%), and it was 29.5% (95% CI, 20.8% to 38.2%) for the 105 patients with pre-emptive RRT. Classic RRT was associated with a higher risk for mortality (adjusted odds ratio, 2.05; 95% CI, 1.03 to 4.09). Forty-four patients with classic-delayed RRT showed higher crude mortality (68.2%; 95% CI, 54.4% to 82.0%) compared with patients with classic-urgent RRT, and this association persisted after adjustment for known confounders (odds ratio, 3.85; 95% CI, 1.48 to 10.22). Crude 90-day mortality of 67 1:1 matched patients with pre-emptive RRT was 26.9% (95% CI, 6.3% to 37.5%), and it was 49.3% (95% CI, 37.3% to 61.2%; P=0.01) for their non-RRT matches. CONCLUSIONS:Patients on RRT after one or more conventional indications had both higher crude and adjusted 90-day mortality compared with patients without conventional indications. These findings require confirmation in an adequately powered, multicenter, randomized controlled trial.
Authors: Catherine S C Bouman; Heleen M Oudemans-Van Straaten; Jan G P Tijssen; Durk F Zandstra; Jozef Kesecioglu Journal: Crit Care Med Date: 2002-10 Impact factor: 7.598
Authors: Tacyano T Leite; Etienne Macedo; Samuel M Pereira; Sandro R C Bandeira; Pedro H S Pontes; André S Garcia; Fernanda R Militão; Irineu M M Sobrinho; Livia M Assunção; Alexandre B Libório Journal: Crit Care Date: 2013-04-02 Impact factor: 9.097
Authors: Suvi T Vaara; Anna-Maija Korhonen; Kirsi-Maija Kaukonen; Sara Nisula; Outi Inkinen; Sanna Hoppu; Jouko J Laurila; Leena Mildh; Matti Reinikainen; Vesa Lund; Ilkka Parviainen; Ville Pettilä Journal: Crit Care Date: 2012-10-17 Impact factor: 9.097
Authors: Ron Wald; Neill K J Adhikari; Orla M Smith; Matthew A Weir; Karen Pope; Ashley Cohen; Kevin Thorpe; Lauralyn McIntyre; Francois Lamontagne; Mark Soth; Margaret Herridge; Stephen Lapinsky; Edward Clark; Amit X Garg; Swapnil Hiremath; David Klein; C David Mazer; Robert M A Richardson; M Elizabeth Wilcox; Jan O Friedrich; Karen E A Burns; Sean M Bagshaw Journal: Kidney Int Date: 2015-07-08 Impact factor: 10.612
Authors: D J Askenazi; Michael Heung; Michael J Connor; Rajit K Basu; Jorge Cerdá; Kent Doi; Jay L Koyner; Azra Bihorac; Ladan Golestaneh; Anitha Vijayan; Mark D Okusa; Sarah Faubel Journal: Blood Purif Date: 2016-12-03 Impact factor: 2.614
Authors: Rinaldo Bellomo; Claudio Ronco; Ravindra L Mehta; Pierre Asfar; Julie Boisramé-Helms; Michael Darmon; Jean-Luc Diehl; Jacques Duranteau; Eric A J Hoste; Joannes-Boyau Olivier; Matthieu Legrand; Nicolas Lerolle; Manu L N G Malbrain; Johan Mårtensson; Heleen M Oudemans-van Straaten; Jean-Jacques Parienti; Didier Payen; Sophie Perinel; Esther Peters; Peter Pickkers; Eric Rondeau; Miet Schetz; Christophe Vinsonneau; Julia Wendon; Ling Zhang; Pierre-François Laterre Journal: Ann Intensive Care Date: 2017-05-04 Impact factor: 6.925
Authors: Mallika L Mendu; George R Ciociolo; Sarah R McLaughlin; Dionne A Graham; Roya Ghazinouri; Siddharth Parmar; Alissa Grossier; Rebecca Rosen; Karl R Laskowski; Leonardo V Riella; Emily S Robinson; David M Charytan; Joseph V Bonventre; Jeffrey O Greenberg; Sushrut S Waikar Journal: Clin J Am Soc Nephrol Date: 2017-01-24 Impact factor: 8.237
Authors: Milo Engoren; Michael D Maile; Michael Heung; James M Blum; Ross Blank; Lena M Napolitano; Pauline K Park; Krishnan Raghavendran; Elizabeth S Jewell; Craig Meldrum Journal: J Intensive Care Soc Date: 2019-12-05
Authors: Ville Pettilä; Tobias Merz; Erika Wilkman; Anders Perner; Sari Karlsson; Theis Lange; Johanna Hästbacka; Peter Buhl Hjortrup; Anne Kuitunen; Stephan M Jakob; Jukka Takala Journal: Trials Date: 2016-08-02 Impact factor: 2.279