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Survival to discharge among patients treated with CRRT
Author(s) -
Wald R.,
Deshpande R.,
Bell C.M.,
Bargman J.M.
Publication year - 2005
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/j.1492-7535.2005.1121au.x
Subject(s) - medicine , renal replacement therapy , oliguria , dialysis , acute kidney injury , hemodialysis , cohort , renal function , surgery
Continuous renal replacement therapy (CRRT) is widely used in critically ill patients with acute renal failure (ARF). The survival of patients who require CRRT and the factors predicting their outcomes are not well defined. We sought to identify clinical features to predict survival in patients treated with CRRT. We reviewed the charts of all patients who received CRRT at the Toronto General Hospital during the year 2002. Our cohort (n = 85) represented 97% of patients treated with this modality in 3 critical care units. We identified demographic variables, underlying diagnoses, transplantation status, location (medical‐surgical, coronary or cardiovascular surgery intensive care units), CRRT duration, baseline creatinine clearance (CrCl), and presence of oliguria (<400 ml/d) on the day of CRRT initiation. The principal outcome was survival to hospital discharge. Among those alive at discharge, we assessed whether there was an ongoing need for renal replacement therapy. Greater than one‐third (38%, 32/85) of patients survived to hospital discharge. Three (9%) of the survivors remained dialysis‐dependent at the time of discharge. Survivors were younger than non‐survivors (mean age 56 vs 60 y.), were on CRRT for a shorter duration (7 vs 13 d.), and had a higher baseline CrCl (79 vs 68 ml/min). Patient survival varied among different critical care units (medical surgical 33%, coronary 38%, and cardiovascular surgery 45%). Multivariable logistic regression revealed that shorter duration of CRRT, non‐oliguria, and baseline CrCl > 60 ml/min were independently associated with survival to hospital discharge (p < 0.05). Critically ill patients with ARF who require CRRT continue to have high in‐hospital mortality. A shorter period of CRRT dependence, non‐oliguria, and higher baseline renal function may predict a more favorable prognosis. The majority of CRRT patients who survive their critical illness are independent from dialysis at the time of hospital discharge.