Stéphane Gaudry1, Jean-Damien Ricard2, Clément Leclaire3, Cédric Rafat3, Jonathan Messika2, Alexandre Bedet3, Lucile Regard3, David Hajage4, Didier Dreyfuss5. 1. AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France; Univ Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, F-75010 Paris, France; INSERM, ECEVE, U1123, F-75010 Paris, France. 2. AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France; Univ Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, F-75018 Paris, France; INSERM, IAME, U1137, F-75018 Paris, France. 3. AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France. 4. AP-HP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, 178 rue des Renouillers, F-92700, Colombes, France; Univ Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, F-75010 Paris, France; INSERM, ECEVE, U1123, F-75010 Paris, France; INSERM, CIE-1425, F-75018, Paris, France. 5. AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France; Univ Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, F-75018 Paris, France; INSERM, IAME, U1137, F-75018 Paris, France. Electronic address: didier.dreyfuss@lmr.aphp.fr.
Abstract
PURPOSE: Renal replacement therapy (RRT) is a major supportive treatment of acute kidney injury (AKI) in intensive care unit (ICU), but the timing of its initiation remains open to debate. MATERIALS AND METHODS: We retrospectively analyzed ICU patients who had AKI associated with at least one usual RRT criteria: serum creatinine concentration greater than 300 μmol/L, serum urea concentration greater than 25 mmol/L, serum potassium concentration greater than 6.5 mmol/L, severe metabolic acidosis (arterial blood pH<7.2), oliguria (urine output<135 mL/8 hours or <400 mL/24 hours), overload pulmonary edema. To estimate the risk of death associated with RRT adjusted for risk factors, we performed a marginal structural Cox model with inverse-probability-of-treatment-weighted estimator. RESULTS: Among 4173 patients admitted to the ICU, 203 patients fulfilled potential RRT criteria. Ninety-one patients (44.8%) received RRT and 112 (55.2%) did not. Non-RRT and RRT patients differed in terms of severity of illness: Simplified Acute Physiology Score II (55±17 vs 60±19, respectively; P<.05) and Sequential Organ Failure Assessment score (8 [5-10] vs 9 [7-11], respectively; P=.01). Crude analysis indicated a lower ICU mortality for non-RRT compared with RRT patients (18% vs 45%; P<.001). In the marginal structural Cox model, RRT was associated with increased mortality (P<.01). CONCLUSION: A conservative approach of AKI was not associated with increased mortality.
PURPOSE: Renal replacement therapy (RRT) is a major supportive treatment of acute kidney injury (AKI) in intensive care unit (ICU), but the timing of its initiation remains open to debate. MATERIALS AND METHODS: We retrospectively analyzed ICU patients who had AKI associated with at least one usual RRT criteria: serum creatinine concentration greater than 300 μmol/L, serum urea concentration greater than 25 mmol/L, serum potassium concentration greater than 6.5 mmol/L, severe metabolic acidosis (arterial blood pH<7.2), oliguria (urine output<135 mL/8 hours or <400 mL/24 hours), overload pulmonary edema. To estimate the risk of death associated with RRT adjusted for risk factors, we performed a marginal structural Cox model with inverse-probability-of-treatment-weighted estimator. RESULTS: Among 4173 patients admitted to the ICU, 203 patients fulfilled potential RRT criteria. Ninety-one patients (44.8%) received RRT and 112 (55.2%) did not. Non-RRT and RRT patients differed in terms of severity of illness: Simplified Acute Physiology Score II (55±17 vs 60±19, respectively; P<.05) and Sequential Organ Failure Assessment score (8 [5-10] vs 9 [7-11], respectively; P=.01). Crude analysis indicated a lower ICU mortality for non-RRT compared with RRT patients (18% vs 45%; P<.001). In the marginal structural Cox model, RRT was associated with increased mortality (P<.01). CONCLUSION: A conservative approach of AKI was not associated with increased mortality.
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: Sean M Bagshaw; Michael Darmon; Marlies Ostermann; Fredric O Finkelstein; Ron Wald; Ashita J Tolwani; Stuart L Goldstein; David J Gattas; Shigehiko Uchino; Eric A Hoste; Stephane Gaudry Journal: Intensive Care Med Date: 2017-03-13 Impact factor: 17.440
Authors: Martin Christ; Katharina Isabel Auenmüller; Scharbanu Amirie; Michael Brand; Benjamin Michel Sasko; Hans-Joachim Trappe Journal: Herzschrittmacherther Elektrophysiol Date: 2015-12-15
Authors: Benjamin T Wierstra; Sameer Kadri; Soha Alomar; Ximena Burbano; Glen W Barrisford; Raymond L C Kao Journal: Crit Care Date: 2016-05-06 Impact factor: 9.097