Continuous Renal Replacement Therapy Liberation and Outcomes of Critically Ill Patients With Acute Kidney Injury

• Published in: Mayo Clinic proceedings Vol. 96; no. 11; p. 2757
• Main Authors: Liu, Chang, Peng, Zhiyong, Dong, Yue, Li, Zhuo, Song, Xuan, Liu, Xinyan, Andrijasevic, Nicole M, Gajic, Ognjen, Albright, Jr, Robert C, Kashani, Kianoush B
• Format: Journal Article
• Language: English
• Published: England 01.11.2021
• Subjects: Acute Kidney Injury - complications; Acute Kidney Injury - diagnosis; Acute Kidney Injury - mortality; Acute Kidney Injury - therapy; Clinical Deterioration; Continuous Renal Replacement Therapy - adverse effects; Continuous Renal Replacement Therapy - methods; Critical Illness - therapy; Duration of Therapy; Female; Humans; Intensive Care Units - statistics & numerical data; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - etiology; Kidney Function Tests; Male; Mortality; Outcome and Process Assessment, Health Care; Patient Acuity; Practice Patterns, Physicians' - standards; Practice Patterns, Physicians' - statistics & numerical data; Recovery of Function; Retrospective Studies
• ISSN: 1942-5546
• DOI: 10.1016/j.mayocp.2021.05.031

To examine the association between continuous renal replacement therapy (CRRT) liberation and clinical outcomes among patients with acute kidney injury (AKI) requiring CRRT. This single-center, retrospective cohort study included adult patients admitted to intensive care units with AKI and treated with CRRT from January 1, 2007, to May 4, 2018. Based on the survival and renal replacement therapy (RRT) status at 72 hours after the first CRRT liberation, we classified patients into liberated, reinstituted, and those who died. We observed patients for 90 days after CRRT initiation to compare the major adverse kidney events (MAKE ). Of 1135 patients with AKI, 228 (20%), 437 (39%), and 470 (41%) were assigned to liberated, reinstituted, and nonsurvival groups, respectively. The MAKE , mortality, and RRT independence rates of the cohort were 62% (707 cases), 59% (674 cases), and 40% (453 cases), respectively. Compared with reinstituted patients, the liberated group had a lower MAKE (29% vs 39%; P=.009) and higher RRT independence rate (73% vs 65%; P=.04) on day 90, but without significant difference in 90-day mortality (26% vs 33%; P=.05). After adjustments for confounders, successful CRRT liberation was not associated with lower MAKE (odds ratio, 0.71; 95% CI, 0.48 to 1.04; P=.08) but was independently associated with improved kidney recovery at 90-day follow-up (hazard ratio, 1.81; 95% CI, 1.41 to 2.32; P<.001). Our study demonstrated a high occurrence of CRRT liberation failure and poor 90-day outcomes in a cohort of AKI patients treated with CRRT.