Martin Bonnassieux1,2, Antoine Duclos3, Antoine G Schneider4, Aurélie Schmidt5, Stève Bénard5, Charlotte Cancalon5, Olivier Joannes-Boyau6, Carole Ichai7,8, Jean-Michel Constantin9, Jean-Yves Lefrant10, John A Kellum11, Thomas Rimmelé1,2. 1. Department of Anesthesiology and Critical Care Medicine, Edouard Herriot hospital, Lyon, France. 2. EA 7426 (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux) "Pathophysiology of Injury-induced Immunosupression - PI3," Joint Research Unit, Edouard Herriot Hospital, Lyon, France. 3. Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, University Claude Bernard Lyon 1, Health Services and Performance Research Lab (EA 7425), Lyon, France. 4. Adult Intensive Care Unit and Burn Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. 5. St[è]ve consultants, Oullins, France. 6. Department of Anesthesiology and Intensive Care II, Magellan Hospital, University Hospital of Bordeaux, University of Bordeaux 2, Pessac, France. 7. Medicosurgical Intensive Care Unit, Pasteur 2, Nice, France. 8. IRCAN Unit, UMR INSERM U1081 - CNRS 7284, Nice Sophia-Antipolis University, Nice, France. 9. Department of perioperative medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France. 10. Department of Critical Care Medicine, CHU Nîmes, Nîmes, France. 11. Center for Critical Care Nephrology, The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
Abstract
OBJECTIVES: Acute kidney injury requiring renal replacement therapy is a major concern in ICUs. Initial renal replacement therapy modality, continuous renal replacement therapy or intermittent hemodialysis, may impact renal recovery. The aim of this study was to assess the influence of initial renal replacement therapy modality on renal recovery at hospital discharge. DESIGN: Retrospective cohort study of all ICU stays from January 1, 2010, to December 31, 2013, with a "renal replacement therapy for acute kidney injury" code using the French hospital discharge database. SETTING: Two hundred ninety-one ICUs in France. PATIENTS: A total of 1,031,120 stays: 58,635 with renal replacement therapy for acute kidney injury and 25,750 included in the main analysis. INTERVENTIONS: None. MEASUREMENTS MAIN RESULTS: PPatients alive at hospital discharge were grouped according to initial modality (continuous renal replacement therapy or intermittent hemodialysis) and included in the main analysis to identify predictors of renal recovery. Renal recovery was defined as greater than 3 days without renal replacement therapy before hospital discharge. The main analysis was a hierarchical logistic regression analysis including patient demographics, comorbidities, and severity variables, as well as center characteristics. Three sensitivity analyses were performed. Overall mortality was 56.1%, and overall renal recovery was 86.2%. Intermittent hemodialysis was associated with a lower likelihood of recovery at hospital discharge; odds ratio, 0.910 (95% CI, 0.834-0.992) p value equals to 0.0327. Results were consistent across all sensitivity analyses with odds/hazards ratios ranging from 0.883 to 0.958. CONCLUSIONS: In this large retrospective study, intermittent hemodialysis as an initial modality was associated with lower renal recovery at hospital discharge among patients with acute kidney injury, although the difference seems somewhat clinically limited.
OBJECTIVES:Acute kidney injury requiring renal replacement therapy is a major concern in ICUs. Initial renal replacement therapy modality, continuous renal replacement therapy or intermittent hemodialysis, may impact renal recovery. The aim of this study was to assess the influence of initial renal replacement therapy modality on renal recovery at hospital discharge. DESIGN: Retrospective cohort study of all ICU stays from January 1, 2010, to December 31, 2013, with a "renal replacement therapy for acute kidney injury" code using the French hospital discharge database. SETTING: Two hundred ninety-one ICUs in France. PATIENTS: A total of 1,031,120 stays: 58,635 with renal replacement therapy for acute kidney injury and 25,750 included in the main analysis. INTERVENTIONS: None. MEASUREMENTS MAIN RESULTS: PPatients alive at hospital discharge were grouped according to initial modality (continuous renal replacement therapy or intermittent hemodialysis) and included in the main analysis to identify predictors of renal recovery. Renal recovery was defined as greater than 3 days without renal replacement therapy before hospital discharge. The main analysis was a hierarchical logistic regression analysis including patient demographics, comorbidities, and severity variables, as well as center characteristics. Three sensitivity analyses were performed. Overall mortality was 56.1%, and overall renal recovery was 86.2%. Intermittent hemodialysis was associated with a lower likelihood of recovery at hospital discharge; odds ratio, 0.910 (95% CI, 0.834-0.992) p value equals to 0.0327. Results were consistent across all sensitivity analyses with odds/hazards ratios ranging from 0.883 to 0.958. CONCLUSIONS: In this large retrospective study, intermittent hemodialysis as an initial modality was associated with lower renal recovery at hospital discharge among patients with acute kidney injury, although the difference seems somewhat clinically limited.
Authors: Song In Baeg; Junseok Jeon; Danbee Kang; Soo Jin Na; Juhee Cho; Kyunga Kim; Jeong Hoon Yang; Chi Ryang Chung; Jung Eun Lee; Wooseong Huh; Gee Young Suh; Yoon-Goo Kim; Dae Joong Kim; Hye Ryoun Jang Journal: Front Med (Lausanne) Date: 2022-08-31