Abstract: SA-PO659

Females Receive Continuous Dialysis Modalities Less Often Than Their Male ICU Counterparts

Session Information

Category: Dialysis

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

Authors

  • Kumar, Neelja D., Albert Einstein College of Medicine; Montefiore Medical Center, Bronx, New York, United States
  • Golestaneh, Ladan, Albert Einstein College of Medicine; Montefiore Medical Center, Bronx, New York, United States
Background

Acute kidney injury (AKI) carries significant mortality with rates as high as 50-70% reported in the Intensive Care Unit (ICU). Standard clinical parameters for hemodialysis (HD) in AKI include azotemia, hyperkalemia, acidosis, and volume overload. Continuous renal replacement therapy (CRRT) is used in hemodynamically unstable patients or those with massive volume overload requiring prolonged ultrafiltration. Initiation of CRRT involves dedicated ICU nursing and is generally more expensive than HD.
Race and initiation of dialysis has been evaluated though data remains conflicted. Gender also influences delivery of care as some studies suggest that males with AKI receive initiation of dialysis less often, while others suggest that women receive less aggressive critical care and dialysis. We hypothesize that certain non-clinical factors like race, socioeconomic status (SES), gender, or location affect the decision to pursue CRRT versus HD.

Methods

We used a clinical database “Clinical Looking Glass” (CLG) to retrospectively analyze 1,519 patients in the ICU between 2012-2015. AKI was defined as creatinine >3.0 mg /dL with pre-admission creatinine < 2.0 mg/dL. Endpoints included: CRRT, HD, Palliative Care or no intervention. Variables evaluated included age, gender, SES, race, vasopressor use, laboratory parameters before RRT initiation, and the type of ICU. We did bivariate analyses examining demographic and clinical variables with treatment assignment. We then built a logistic regression model to test our hypothesis.

Results

A total of 370 subjects (24.4%) received CRRT, 307(20.2%) received HD, 264(17.4%) received palliative care and 578(38%) received no intervention. In the cohort, 46.7% were female, 32.8% were black and 18.3% were white; with a mean age of 63.3 years. Our logistic regression model included 408 subjects and showed a significant association between gender and type of RRT received, with females having a significantly lower odds of receiving CRRT(odds ratio: 0.58, CI(0.37-0.89), as compared to HD, after adjusting for other variables. Other variables significantly associated with use of CRRT were vasopressor use, lower pH, lower creatinine, type of ICU, and hospital location.

Conclusion

Female patients were less likely to receive CRRT than males. Other factors including race and SES did not significantly affect the decision to start CRRT versus HD.