Abstract: SA-PO657

Mortality after Continuous Renal Replacement Therapy (CRRT) in Maintenance Hemodialysis Patients: A Scoring System of Short-Term Mortality Risk after CRRT

Session Information

Category: Dialysis

  • 602 Dialysis for AKI: Hemodialysis, CRRT, SLED, Others

Authors

  • Hamada, Toma, Showa University School of Medicine, Tokyo, Japan
  • Mizobuchi, Masahide, Showa University School of Medicine, Tokyo, Japan
  • Shikida, Yasuto, Showa University School of Medicine, Tokyo, Japan
  • Shibata, Takanori, Showa University School of Medicine, Tokyo, Japan
Background

Critically ill patients, suffering from serious diseases such as acute heart failure, acute kidney injury, septic shock, and so on, often require continuous renal replacement therapy (CRRT). Little is known about the outcome of CRRT in maintenance hemodialysis (MHD) patients, and what clinical parameters are risk factors of short-term mortality after CRRT. The objective was to investigate whether MHD patients are at high risk of the short term mortality after CRRT and to determine a scoring system relating to the mortality.

Methods

In this study, 308 patients who required CRRT in our facility from April 2013 to March 2015 were retrospectively analyzed. We excluded patients who were indicated HD within 7 days before CRRT, transferred to other hospital, and lost to follow. Patients were stratified by two groups, MHD group and Non-MHD (control) group. Analyses were performed using JMP.

Results

Two hundred fifty eight patients are included in the study. Sixty five % of them were male, mean age was 71 years. Cumulative incidence of death for MHD group versus control group was 60.4 % versus 46.0 % at 30 days (p=0.09), respectively. Kaplan-Meier analysis revealed that MHD group (log-rank test: p=0.02), intubated patients (log-rank test: p < 0.0001) had significant lower cumulative survival rate at 30-days after CRRT. Logistic regression analysis revealed that MHD patients were likely to die within 30-days after CRRT but did not reach statistically significance (unadjusted odds ratio 1.79; 95 % CI 0.92 – 3.54). After adjustment for elderly (age over 65 years), catecholamine administration, intubation, and MHD, MHD was an independent risk factor for 30-days mortality after CRRT (adjusted odds ratio 2.75; 95 % CI 1.31 – 5.94; p = 0.0067). We formulated a scoring system. The scoring system, MEIC score, was derived as follows: (MHD×5) +(Elderly(Age>65 y)×3)+(Intubation×7) + (Catecholamine×5) . The area under the ROC curve was 0.73 for the MEIC score.

Conclusion

These results suggested that MHD, intubation, elderly, catecholamine administration were independent risk factors of 30-days mortality after CRRT. The MEIC score could be a useful scoring system for the short-term mortality.