Abstract: FR-PO139
Impact of Early Renal Replacement Therapy in Leptospirosis on Mortality and Long-Term Renal Function: A Retrospective Analysis over 11 Years in Reunion Island
Session Information
- AKI: Outcomes, RRT
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Julien, Marie, Hopital Tenon, Paris, Île-de-France, France
- Lombardi, Yannis, Hopital Tenon, Paris, Île-de-France, France
- Jabot, Julien, Centre Hospitalier Universitaire de La Reunion, Saint-Denis, La Réunion, Réunion
- Rafat, Cedric, Hopital Tenon, Paris, Île-de-France, France
Background
Leptospirosis is a widespread zoonosis that can cause severe acute kidney injury (AKI-L) and remote chronic renal disease (CKD-L). Anecdotal evidence suggests that early renal replacement therapy (RRT) may improve mortality associated with AKI-L. Conversely, intensive care unit (ICU)-based trials, including the landmark AKIKI carried have disproved a positive impact of early RRT on patient mortality. We aimed to determine i) whether the timing of RRT positively impacts mortality ii) provide an estimation of the incidence of post-leptospirosis CKD.
Methods
We conducted a retrospective study over 11 years in Reunion Island, including adult patients with confirmed leptospirosis complicated by KDIGO 2 or 3 AKI.The primary endpoint was a composite endpoint including death and CKD-L up to 3 years after hospital discharge. Factors associated with CKD-L and death were determined using logistic regression models with different adjustment variables.
Results
Three hundred eighty patients were included, 39% of whom required RRT with a median time to initiation of 1 day (0-2 days).According to the composite criterion, the mortality rate was 4% in the study population and the incidence of CKD-L was 8%.On univariate analysis, factors associated with the composite criterion included ICU severity scores, age, baseline kidney function, oligo-anuria and the need for RRT. Using bivariate models adjusting on age or SAPS2 or prior renal function, we showed that when compared to patients who did not require dialysis, no significant difference was found between early or late dialysis initiation on the composite endpoint. Odds ratio (OR) for RRT before 24h was 5.7 (1.9-17.9) and OR for RRT after 24h was 5.7 (2.1-16.3).
Conclusion
In conclusion, leptospirosis accounts for significant CKD. Early RRT does not seem to improve the composite mortality-CKD endpoint. Further investigations are needed to substantiate the potentially protective effects of early RRT on CKD-L.
Bivariate analysis of factors associated with death or CKD at last follow-up, according to time to initiation of RRT and patients' SAPS2 score
| Variable | OR | CI 95% | p |
| RRT < 24 hours | 5.7 | 1.9 - 17.9 | < 0.01 |
| RRT > 24 hours | 5.7 | 2.1 - 16.3 | < 0.001 |
| SAPS2, per unit | 1.1 | 1 - 1.1 | < 0.001 |