K KARPE1,2, S RAI, V DAMODARAN2
1Renal Services, Canberra Hospital, Garran, Australia, 2Australian National University Medical School, Acton, Australia, 3Intensive Care Unit, Canberra Hospital, Garran, Australia
Background: Acute Kidney Injury (AKI) requiring Continuous Renal Replacement Therapy (CRRT) in the Intensive care unit (ICU) is known to be associated with high short-term mortality. Long-term outcomes of such patients is not well studied.
Aims: To determine risk factors for mortality of ICU patients with AKI requiring CRRT and long-term outcomes
Methods: Adult patients admitted to the ICU with AKI requiring CRRT were included. ICU, hospital electronic records and renal database were interrogated for outcome measures.
Outcomes: Mortality and dialysis dependence. Univariate and multivariate regression analysis were performed to identify predictors of dialysis and mortality at one-year.
Results: A total 190 patients were analysed in the 2 year study period after excluding patients with pre-existing ESRD and readmissions.
The median length of hospital and ICU stay for these patients were 16 days and 3 days respectively. Hospital mortality was 37.4% which increased to 55.6% at one-year. At one-year 6.3% patients were still dependent on dialysis. On univariate analysis, heparin circuit anticoagulation(OR 0.52, CI 0.35 – 0.77) and creatinine level on ICU admission ( p=0.02) were associated with reduced mortality. Creatinine level on ICU admission (OR 1.65 p=0.04), was associated with dialysis dependence at one year. On multivariate analysis only APACHE II score was a significant predictor of mortality at one year with an OR 1.06, per one unit increase in score (p=0.02). High proportion of survivors (40.3%) had increased healthcare utilization with ≥ 2 hospital readmissions at one-year.
Conclusions: Although critically ill patients with AKI treated with CRRT have high one- year mortality at 55.6%, only a small proportion of survivors (6.3%) are still dependent on dialysis.
Dr Krishna Karpe is a Nephrologist at the Canberra Hospital Renal Services and lecturer at the Australian National University Medical school