Abstract: FR-PO037
Change in Right Ventricular Systolic Function After CRRT Initiation and Renal Recovery
Session Information
- AKI: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
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
Echocardiographic parameters have been associated with outcomes in patients on continuous renal replacement therapy (CRRT). We investigate the impact of CRRT on echocardiographic parameters and the association between improvement of these parameters with renal recovery and mortality.
Methods
This is a retrospective analysis of patients admitted to the intensive care units (ICU) at a tertiary care hospital from December 2006 through November 2015 who underwent CRRT and had an echocardiogram available within ±2 weeks from CRRT initiation. The primary outcome was Major Adverse Kidney Events at day 90(MAKE90). Multivariate logistic regression was performed to identify independent predictors of MAKE90. Secondary outcome included mortality at 30 days.
Results
The cohort included 303 patients with acute kidney injury (AKI). The median age was 62 (IQR 52-71) years with 130 (43%) female and median SOFA on the day of CRRT initiation 12 (IQR 10-14). Overall MAKE90 occurred in180 (60%) patients. The median time of echocardiogram relative to CRRT initiation was 1 day prior to CRRT and 4 days after the CRRT initiation. Among 136 patients, 35 (25%) had improvement in RV systolic function on the repeat echocardiogram. Among 106 patients, 47 (44%) had improvement in their RVSP, and 23 (21%) had at least 20% lower RVSP. Rates of MAKE90 were lower in patients who had improvement in their RV systolic function (43% vs. 67%), or had 20% reduction in RVSP (35% vs 59%), p<0.05 for both. On multivariate logistic regression, the improvement in RV systolic function (adjusted OR 0.33; 95%CI: 0.14-0.76, p=0.008) and decrease in RVSP by >20%(OR 0.36; 95%CI: 0.13-0.98, p=0.047) were associated with lower MAKE90 after adjusting for age, SOFA score, fluid balance before CRRT initiation and baseline serum creatinine. For 30-day mortality, adjusted hazard ratio (HR) for improvement in RV systolic function was 0.48 (95%CI: 0.24-0.93, p=0.031). Patients who had an improvement in their RV systolic function were in negative fluid balance leading to the day of repeat echocardiogram -2.1L vs. + 0.22L p=0.026.
Conclusion
Right ventricular dysfunction has been previously shown to predict mortality in ICU patients. Improvement in RV systolic function after CRRT was associated with decreased mortality and better renal recovery and this might be affected by volume overload.