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Kidney Week

Abstract: SA-PO557

Hypotension within One-Hour from Starting CRRT Is an Independent Predictor for In-Hospital Mortality

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Shawwa, Khaled, Mayo Clinic, Rochester, Minnesota, United States
  • Kompotiatis, Panagiotis, Mayo Clinic, Rochester, Minnesota, United States
  • Wiley, Brandon M., Mayo Clinic , Rochester, Minnesota, United States
  • Jentzer, Jacob, Mayo Clinic, Rochester, Minnesota, United States
  • Kashani, Kianoush, Mayo Clinic , Rochester, Minnesota, United States
Background

In-hospital mortality in critically ill patients who require renal replacement therapy is high. Patients who receive CRRT may be at higher risk for hemodynamic instability that can have implications in terms of renal recovery and mortality.

Methods

This is a retrospective analysis of a cohort of patients admitted to the ICUs at a tertiary care hospital from December 2006 through November 2015 who underwent CRRT. The primary outcome was in-hospital mortality. Multivariate logistic regression was performed to identify independent predictors of in-hospital mortality. Hypotension within the first hour of CRRT initiation was defined as: MAP <60 mm Hg, SBP <90 mm Hg or a decline in SBP >40 mm Hg from baseline, a positive fluid balance more than 500 ml or increased vasopressor requirement.

Results

The analysis included 1,743 patients, 345 (19.8%) with ESRD and 1,398 (80.2%) with AKI. The median age was 63 (IQR 53-73) years with 699 (40%) female, median Charlson comorbidity index 5 (IQR 3-7) and median SOFA on the day of CRRT initiation was 12 (IQR 9-14). Overall in-hospital mortality occurred was 50%. Hypotension within one hour of CRRT initiation occurred in 64% of the patients. Predictors of in-hospital mortality in univariate analysis included: SOFA score (OR 1.13 per 1 unit increase, 95% CI:1.10-1.16), mechanical ventilation (OR 1.6, 95% CI:1.2-2.1), hypotension within 1 hour (OR 1.6, 95% CI:1.3-1.9), AKI compared to ESRD (OR 1.9, 95% CI:1.5-2.5) and modified shock index (OR 2.1 per 1 unit increase, 95% CI:1.7-2.7). Hypotension within one hour of CRRT initiation remained an independent predictor of in-hospital mortality (OR 1.45, 95% CI:1.15- 1.82, p=0.001), after adjusting for age, gender, SOFA score, mechanical ventilation, fluid balance between ICU admission and CRRT initiation, modified shock index, Charlson comorbidity index, AKI vs ESRD, ICU type, creatinine closest to CRRT initiation and ICU day number when CRRT was initiated.

Conclusion

Hypotension occurs frequently in patients receiving CRRT despite being chosen as a modality with better hemodynamic tolerance. Hypotension during the first hour after initiating CRRT is a significant independent risk factor for in-hospital mortality. Further studies are required to help understand this phenomenon given its implications for in-hospital mortality.