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Abstract: PO0004

A Meta-Analysis of Clinical Predictors for Renal Recovery and Mortality in AKI Requiring Continuous Renal Replacement Therapy

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Hansrivijit, Panupong, UPMC Pinnacle, Harrisburg, Pennsylvania, United States
  • Puthenpura, Max, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States
  • Ghahramani, Nasrollah, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Thongprayoon, Charat, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Cheungpasitporn, Wisit, University of Mississippi Medical Center, Jackson, Mississippi, United States
Background

Acute kidney injury (AKI) is a common complication in critically ill patients and can result in a broad spectrum of severity. It is well-established that severe AKI requiring continuous renal replacement therapy (CRRT) carries a significant risk for increased mortality compared to non-dialysis AKI. However, there are no concensus guidelines describing the discontinuation criteria from CRRT. Thus, we performed this meta-analysis to determine the clinical predictors for CRRT discontinuation and overall mortality in patients with AKI.

Methods

Ovid MEDLINE, EMBASE, and Cochrane Library were searched without language restrictions up to January 2020. Our inclusion criteria included patients ≥ 18 years of age, non-end-stage kidney disease patients who required CRRT for AKI. Renal recovery was defined by CRRT discontinuation. Intermittent hemodialysis was excluded. Only articles utilizing multivariate analysis were included. We divided our analyses into two cohorts based on the primary outcomes: renal recovery cohort and overall mortality cohort.

Results

For renal recovery cohort (n = 4,497 from 14 studies), the mean effluent dose of CRRT was 24.93 ± 5.87 ml/kg/h with a median duration of CRRT of 3.75 days (IQR 2.45). Increasing urine output at time of CRRT discontinuation (per 100 ml/day), elevated initial SOFA score (per 1 score) and serum creatinine level at CRRT initiation (per 1.0 mg/dl) were predictive of renal recovery with odds ratio of 1.021 (95% CI, 1.012-1.031), 0.890 (95% CI, 0.805-0.984) and 0.995 (95% CI, 0.991-0.999), respectively. For overall mortality cohort (n = 16,948 from 11 studies), The mean effluent dose of CRRT was 26.22 ± 6.47 ml/kg/h with a median CRRT duration of 4.5 days (IQR 3.40). Age (per 1 year) and presence of sepsis were significantly associated with overall mortality with odds ratio of 1.023 (95% CI, 1.006-1.040) and 2.031 (95% CI, 1.267-3.257), respectively. All analyses remained significant through sensitivity analyses. No potential publication bias was identified.

Conclusion

Urine output at CRRT discontinuation, initial SOFA score, and serum creatinine level are predictive of renal recovery and successful CRRT discontinuation. Increasing age and the presence of sepsis are independent risk factors for elevated overall mortality.