Abstract: FR-PO058
Early High-Dose Thiamine Supplementation for Dialysis-Requiring Septic AKI: A Nationwide Inpatient Database Study
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
- Miyamoto, Yoshihisa, the University of Tokyo Hospital, Tokyo, Japan
- Iwagami, Masao, the University of Tsukuba, Tsukuba, Japan
- Hamasaki, Yoshifumi, University of Tokyo, Tokyo, Japan
- Nangaku, Masaomi, the University of Tokyo School of Medicine, Tokyo, Japan
- Doi, Kent, University of Tokyo, Tokyo, Japan
Background
Recent studies have reported that high dose thiamine supplementation potentially reduces mortality and progression of acute kidney injury (AKI). However, these studies had small sample size and the impact of thiamine is still controversial. Therefore, we investigated the association of early thiamine supplementation with mortality and short-term non-recovery from renal replacement therapy (RRT), using a propensity-score inverse probability of treatment weighting in a cohort of septic dialysis-requiring acute kidney injury.
Methods
In this retrospective observational study using the Japanese nationwide Diagnosis Procedure Combination inpatient database during a period between April 2010 and March 2017, we identified patients with septic AKI who required continuous renal replacement therapy within 2 days of admission. Patients were divided into those who received high dose (100 mg or more) thiamine supplementation within 2 days of admission (thiamine group) and those who did not (control group). We performed propensity-score inverse probability of treatment weighting to adjust for measured confounders. Primary outcome was 28-day mortality and secondary outcome included in-hospital mortality and major adverse kidney events (MAKE), which was defined as death and RRT-dependence at discharge.
Results
A total of 9,927 patients (2809 in thiamine group and 7118 in control group) were eligible. The 28-day mortality was 31.5% (884/2809) in thiamine group and 30.5% (2168/7118) in control group. After adjustment for confounders (a total of 49 covariates, including comorbidities and co-interventions by inverse probability of treatment weighting, there were no significant differences in 28-day mortality between the two groups (adjusted risk difference, 0.2%; 95% adjusted confidence interval [CI], -2.0% to 2.3%). There were no significant differences in in-hospital mortality (adjusted risk difference, 0%; -2.4% to 2.3%), in MAKE (adjusted risk difference, -0.4%; -2.8% to 2.0%), nor in RRT dependence at discharge (adjusted risk difference, -0.4%; -1.5% to 0.7%).
Conclusion
Early high dose thiamine supplementation was not associated with decrease in mortality or MAKE, in patients with septic dialysis-requiring AKI.