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Kidney Week

Abstract: TH-PO008

Post-Discharge Major Adverse Cardiovascular Events of Intensive Care Unit Survivors Who Received Acute Renal Replacement Therapy: A Nationwide Population Based Study

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Park, Sehoon, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Lee, Soojin, Seoul national university hospital, Seoul, Korea (the Republic of)
  • Kang, Min woo, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Kim, Yaerim, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • An, Jung Nam, Seoul National University Boramae Medical Center, Seoul, Seoul, Korea (the Republic of)
  • Joo, Kwon Wook, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Lim, Chun Soo, Seoul National University Boramae Medical Center, Seoul, Seoul, Korea (the Republic of)
  • Kim, Yon Su, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  • Kim, Dong Ki, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
Background

The long-term risk of a major adverse cardiovascular events (MACE) in intensive care unit (ICU) survivors who underwent acute renal replacement therapy (ARRT) requires further investigation.

Methods

We performed a nationwide population-based study using the claims database of Korea, including ICU survivors in over 40 government-designated tertiary hospitals from 2005 to 2016. The study group consisted of ICU survivors who underwent ARRT, and the control group consisted of those without ARRT. Patients were excluded if they 1) were under age 20, 2) expired within 30 days after discharge, 3) received ICU care for less than 24 hours, 4) had a previous ICU admission, 5) had a history of MACE or MACE-related cardio/cerebrovascular diseases. The outcomes of the patients who received CRRT were compared with those of patients who received only intermittent renal replacement therapy (IRRT). The main outcome was MACE, including acute myocardial infarction, revascularization, and acute ischemic stroke. Patient mortality and progression to end-stage renal disease were also evaluated.

Results

We included 12,380 ARRT patients and 382,018 patients in the control group. Among the study group, 6,891 patients were included in the CRRT group, and 5,034 in the IRRT group. The risks of MACE [adjusted hazard ratio (HR) 1.463 (1.323-1.619), P<0.001], all-cause mortality [adjusted HR 1.323 (1.256-1.393), P<0.001], and end-stage renal disease [adjusted HR 18.110 (15.779-20.786), P<0.001] were higher in the ARRT patients than the control group. When we compared the CRRT patients to the IRRT patients, the risk of a MACE was comparable [adjusted HR 1.049 (0.888-1.239), P=0.575].

Conclusion

Clinicians should note the increased risk of a long-term MACE in ARRT survivors and consider appropriate risk factor management. Receiving CRRT did not increase the risk of MACE when compared to receiving IRRT only.