Milo Engoren 1 , Michael D Maile 1 , Michael Heung 2 , James M Blum 3 , Ross Blank 1 , Lena M Napolitano 4 , Pauline K Park 4 , Krishnan Raghavendran 4 , Elizabeth S Jewell 1 , Craig Meldrum 4 Show Affiliations »
Abstract
PURPOSE: To determine if earlier initiation of renal replacement therapy (RRT) is associated with improved survival in patients with severe acute kidney injury. METHODS: We performed a retrospective case-control study of propensity-matched groups with multivariable logistic regression using Akaike Information Criteria to adjust for non-matched variables in a surgical ICU in a tertiary care hospital. RESULTS: We matched 169 of 205 (82%) patients with new initiation of RRT (EARLY group) to 169 similar patients who did not initiate RRT on that day (DEFERRED group). Eighteen (11%) of DEFERRED eventually received RRT before discharge. By univariate analysis, ICU mortality was higher in EARLY (n = 60 (36%) vs. n = 23 (14%), p < 0.001) as was hospital mortality (n = 73 (43%) vs. n = 44 (26%), p = 0.001). Of the 18 RRT patients in DEFERRED, 12 (67%) died in ICU and 13 (72%) in hospital. After propensity matching and logistic regression, we found that EARLY initiation of RRT was associated with a more than doubling of ICU mortality (aOR = 2.310, 95% confidence interval = 1.254-4.257, p = 0.007). However, after similar adjustment, there was no difference in hospital mortality (aOR = 1.283, 95% CI = 0.753-2.186, p = 0.360). CONCLUSIONS: While ICU mortality was increased in the EARLY group, there was no difference in hospital mortality between EARLY and DEFERRED groups. © The Intensive Care Society 2019.
PURPOSE: To determine if earlier initiation of renal replacement therapy (RRT) is associated with improved survival in patients with severe acute kidney injury. METHODS: We performed a retrospective case-control study of propensity-matched groups with multivariable logistic regression using Akaike Information Criteria to adjust for non-matched variables in a surgical ICU in a tertiary care hospital. RESULTS: We matched 169 of 205 (82%) patients with new initiation of RRT (EARLY group) to 169 similar patients who did not initiate RRT on that day (DEFERRED group). Eighteen (11%) of DEFERRED eventually received RRT before discharge. By univariate analysis, ICU mortality was higher in EARLY (n = 60 (36%) vs. n = 23 (14%), p < 0.001) as was hospital mortality (n = 73 (43%) vs. n = 44 (26%), p = 0.001). Of the 18 RRT patients in DEFERRED, 12 (67%) died in ICU and 13 (72%) in hospital. After propensity matching and logistic regression, we found that EARLY initiation of RRT was associated with a more than doubling of ICU mortality (aOR = 2.310, 95% confidence interval = 1.254-4.257, p = 0.007). However, after similar adjustment, there was no difference in hospital mortality (aOR = 1.283, 95% CI = 0.753-2.186, p = 0.360). CONCLUSIONS: While ICU mortality was increased in the EARLY group, there was no difference in hospital mortality between EARLY and DEFERRED groups. © The Intensive Care Society 2019.
Entities: Chemical
Keywords:
Acute kidney injury; creatinine; propensity matching; renal replacement therapy
Year: 2019
PMID： 33643427 PMCID： PMC7890751 DOI： 10.1177/1751143719892792
Source DB: PubMed Journal: J Intensive Care Soc ISSN： 1751-1437