Abstract: TH-PO0726
Evaluating Multicenter CRRT Dose Delivery: Results from the CRRTnet Registry
Session Information
- AKI: Critical Care, CKRT, Cardiorenal Syndromes, and Clinical Outcomes
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Nombera-Aznaran, Natalia R., The University of Alabama at Birmingham, Birmingham, Alabama, United States
- Lambert, Joshua, University of Cincinnati, Cincinnati, Ohio, United States
- Rewa, Oleksa G., University of Alberta, Edmonton, Alberta, Canada
- Heung, Michael, University of Michigan, Ann Arbor, Michigan, United States
- House, Andrew A., London Health Sciences Centre, London, Ontario, Canada
- Juncos, Luis A., University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Chan, Lili, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Bagshaw, Sean M., University of Alberta, Edmonton, Alberta, Canada
- Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Neyra, Javier A., The University of Alabama at Birmingham, Birmingham, Alabama, United States
Group or Team Name
- CRRTnet Investigators
Background
CRRT dose delivery is frequently affected by multiple factors resulting in a gap between the prescribed and delivered dose. This study examines the relationship between prescribed vs. delivered dose gap and mortality.
Methods
We performed a secondary analysis of CRRTnet, a prospective, multicenter cohort of adults receiving CRRT. We included adults aged 18-89 years with AKI and ≥48 hours of machine-logged CRRT data. Patients with ESRD were excluded. Observation days were limited to CRRT days 0 through 6. Prescribed dose was estimated from hourly delivered dose and machine downtime data. A dose gap event was defined as a prescribed dose ≥2.5 mL/kg/h above the delivered dose. Dose gap events were assessed daily (from prior day) and cumulative (average from CRRT initiation through prior day) to create lagged models not affected by acute changes in clinical condition. Generalized estimating equations were used to analyze next-day and 2-day mortality. Models were adjusted for age, CCI, APACHE II score (at ICU admission), and daily SOFA score.
Results
597 patients comprising 2525 CRRT patient-days were analyzed. The cohort consisted of 38% women and had a median (IQR) age of 60 (51-69) years, CCI of 2 (1-4) and SOFA score at CRRT initiation of 13 (10-16). Cumulative 7-day mortality was 21.4%. Median prescribed and delivered CRRT doses were 32.2 (27.8-40) and 29.3 (24.8-35.8) mL/kg/h, respectively. The median of gap events was 6.3 (4.8-7.9) event/day. Each cumulative gap event/day was associated with higher odds of next-day mortality (aOR 1.078; 95% CI 1.015-1.144; p=0.014). Single prior day gap events showed a similar but non-significant association with next-day mortality (aOR 1.047; 95% CI 0.997-1.100; p=0.065). No significant associations were observed with 2-day mortality (Figure 1).
Conclusion
Higher cumulative prescribed vs. delivered CRRT dose gap events were independently associated with higher risk of next-day mortality during the first week of CRRT. These findings suggest that CRRT delivery processes could impact clinical outcomes, and therefore efforts of CRRT standardization and quality improvement should be prioritized.
Funding
- NIDDK Support – Baxter/Vantive