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Kidney Week

Abstract: PO0010

CRRT Is Associated with Improved Kidney Recovery from Dialysis-Requiring AKI in a Multicenter Retrospective Analysis

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Arthur, John M., University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
  • Neyra, Javier A., University of Kentucky, Lexington, Kentucky, United States
  • Gokun, Yevgeniya, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
  • Obeid, Jihad S., Medical University of South Carolina, Charleston, South Carolina, United States
  • Budisavljevic, Milos N., Medical University of South Carolina, Charleston, South Carolina, United States
  • Redden, David, The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Connor, Michael J., Emory University, Atlanta, Georgia, United States
  • Chen, Jin, University of Kentucky, Lexington, Kentucky, United States
  • Liu, Lucas Jing, University of Kentucky, Lexington, Kentucky, United States
  • Syed, Mahanazuddin, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
  • Baghal, Ahmad, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
  • Craig, Jean, Medical University of South Carolina, Charleston, South Carolina, United States
  • Harmon, Brian, The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Narasimha Krishna, Vinay, The University of Alabama at Birmingham, Birmingham, Alabama, United States

Group or Team Name

  • The Southern Acute Kidney Injury Network (SAKInet)
Background

AKI requiring dialysis (AKI-D) is common with a high rate of adverse outcomes. Little is known about modifiable factors that promote kidney recovery.

Methods

Five CTSA universities (UAMS, UAB, UKY, MUSC and Emory) formed a consortium to identify modifiable risk factors for kidney recovery in AKI-D patients. We selected all patients that received dialysis while in the hospital, then excluded patients from the cohort with a diagnosis related to ESKD, kidney transplantation or CKD stage V at the time of the first RRT. Modality of dialysis, comorbidities and outcomes were analyzed.

Results

The total number of patients in the four available cohorts was 4537 (range 647-1477). Outcomes were determined at the time of discharge from the hospital. The primary outcomes in the study were death (n=2190, 48.3%), alive and dialysis-dependent at discharge (n=1160, 25.6%) or alive and dialysis-free at discharge (n=1187, 26.2%). We defined dialysis dependence as receiving dialysis within the last four days of hospitalization. We compared patients that were initiated on CRRT to patients that were initiated on intermittent hemodialysis (iHD) while adjusting for confounders: sepsis, age, race, gender, qSOFA, mechanical ventilation, serum bicarbonate and serum potassium at the time of dialysis initiation. We analyzed hospital cohorts separately. There was a higher risk of death in patients initiated on CRRT vs. iHD. The odds ratios and 95% CIs for death were: UAMS 2.8, 1.9-4.2; UAB 3.2, 2.1-4.9; MUSC 3.7, 2.6-5.3 and UKY 3.1, 2.3-4.2. Among survivors, patients started on CRRT generally had a lower risk of being dialysis-dependent at discharge. The odds ratios and 95% CIs for renal recovery were: UAMS 0.1, 0.04-0.2; UAB 0.3, 0.1-0.5; MUSC 0.3, 0.2-0.5 and UKY 0.8, 0.5-1.2.

Conclusion

The odds of kidney recovery were significantly better for patients started on CRRT in three of the four cohorts examined in this study and trended toward favoring CRRT in the fourth. This has important implications for care of patients with AKI in the ICU. We believe the increased mortality in the CRRT group reflects the sicker nature of patients in that group and is not inherent to CRRT as an initial dialysis modality.

Funding

  • Other NIH Support