Renal replacement therapy in the critically ill
Year: 2012
Type: dissertation
Study design: Observational Study
Abstract: Acute kidney injury (AKI), defined as an abrupt decrease in kidney function, is frequent among intensive care unit (ICU) patients and increases their morbidity and mortality. Severe AKI is treated with renal replacement therapy (RRT). Of all general ICU patients, 3% to 8% receive RRT for AKI. Patients with RRT have high mortality rates, up to 50% to 60%; as such, improvements in their treatment are clearly warranted. Thus, the objectives of this study were to evaluate the incidence and outcome of critically ill patients receiving RRT for AKI in Finland. The association of ICU size and presence of fluid overload at RRT initiation with outcome were investigated and the provided RRT described. Additionally, the quality of published pharmacokinetic studies in patients receiving continuous RRT was studied. The population-based incidence of RRT for AKI, the outcome of these patients, and outcome-associated factors were evaluated first in a retrospective cohort including 24 904 adult patients treated in 24 Finnish ICUs during 2007-2008, of which 1686 (6.8%) received RRT for AKI. The population-based incidence of RRT for AKI was 20 per 100 000 adults per year. The hospital mortality of RRT-treated patients was 35%, and the 6-month mortality was 49%. Patients with RRT who were treated in small central hospitals had higher crude and adjusted hospital mortality rates compared to those treated in larger hospitals. Second, a prospective cohort study included 296 adult patients with RRT in 17 Finnish ICUs over a five-month period in 2011-2012. The 90-day mortality of RRT-treated patients was 39%. Presence of fluid overload at RRT initiation was associated with an increased risk for 90-day mortality. RRT was initiated after a median of 14 hours from ICU admission in the presence of a median of three indications. Initially, 73% of the patients received continuous RRT and the used continuous RRT dose was in line with the current recommendations. Altogether 49 original publications reporting pharmacokinetic results of adult critically ill patients receiving continuous RRT were included in a systematic review. The general quality of these studies was moderate, while the reporting of RRT-related parameters remained inadequate. The used continuous RRT dose was mainly according to recommendations. In summary, the population-based incidence of RRT for AKI was broadly in line with reports from other regions. The mortality rates of these patients were high compared to other ICU-treated syndromes, but lower than previously reported for this patient group. Patients treated with RRT in small ICUs and those with fluid overload at RRT initiation demonstrated worse outcome. The reporting of parameters related to continuous RRT in pharmacokinetic studies was inadequate.
Source: Työväentutkimus Vuosikirja
Author: Suvi T. Vaara
Language: English
Topic: Acute Kidney Injury Research
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2273816365