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Kidney Week

Abstract: TH-PO284

Continuous Renal Replacement Therapy vs. Intermittent Hemodialysis: Outcomes of Critically Ill Patients with AKI

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Akkari, Abdel-Rauof M., Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Sardar, Sundus, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Gul Yousaf Khan, Mohammad, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Ghahramani, Nasrollah, Penn State College of Medicine, Hershey, Pennsylvania, United States

Group or Team Name

  • Dept of Medicine-Division of Nephrology, Pennsylvania State University College of Medicine - Hershey Medical Center.
Background

Acute kidney injury (AKI) is a commonly diagnosed condition in critically ill patients, which poses a significant risk of chronic kidney disease, end-stage renal disease, and dialysis dependence (DD). Renal replacement therapies, including continuous renal replacement therapy (CRRT) and intermittent hemodialysis (iHD), are often used to support AKI patients. Although each modality has benefits, results from studies of outcomes associated with each modality remain inconclusive.

Methods

This retrospective multicenter cohort study utilized the TriNetX, a global federated health research network, to access deidentified electronic medical records from multiple large healthcare organizations. The primary objective was to investigate the outcomes of critically ill patients with AKI who received either CRRT or iHD after propensity score matching. The study identified and compared a total of 1024 propensity score-matched AKI patients in each group from Jan 2012, assessing them for 30-day mortality and DD using odds ratio (OR), 95% confidence interval (CI), hazard ratio (HR), log-rank test, and Kaplan-Meier survival analysis. Additionally, the study identified and compared a propensity-matched subgroup of 195 patients on mechanical ventilation in each group, with platelet count < 100/mL and bilirubin > 6 mg/dL and assessed these outcomes.

Results

The study was conducted on two groups, CRRT versus iHD, each consisting of 1024 patients. The 30-day mortality rate was 537 patients in the iHD group, and 672 patients in the CRRT group [OR: 0.578; 95% CI: 0.743-0.860; HR: 0.692; 95% CI: 0.617-0.775; p=0.637]. DD was observed in 114 and 93 patients in the iHD and CRRT groups, respectively [OR:1.254; 95% CI: 0.940-1.674; HR:1.125; 95% CI: 0.855-1.480; p=0.150]. In subgroup analysis 30-day mortality was reported in 100 and 110 patients and survival probability of 47.61% and 41.76% in the iHD and CRRT groups respectively, [HR: 0.851; 95% CI: 0.649-1.115; p=0.790]. DD was observed in 25 patients in both cohorts.

Conclusion

In the cohort of critically ill patients with acute kidney injury who were admitted to the intensive care unit and required renal replacement therapy, the choice of renal replacement therapy modality did not have a significant impact on either 30-day mortality or the development of dialysis dependence.