Critically ill patients with acute kidney injury (AKI) are at increased risk of death within 24 hours of being placed on continuous renal replacement therapy (CRRT) if they have a high fraction of inspired oxygen (FiO2) or high norepinephrine, according to study findings presented at the European Renal Association-European Dialysis and Transplant Association 53rd Congress in Vienna.
This Canadian prospective study, by Bhanu Prasad, MBBS, FRCPC, of the Regina Qu’Appelle Health Region, and colleagues, included 2,634 patients admitted to intensive care units (ICU) from April 2013 to September 2014. Of the 269 patients with stage 3 AKI, 66 died in the ICU while on CRRT, 17 within 24 hours of initiating therapy.
Compared with patients who survived the first 24 hours, those who died within 24 hours had significantly higher FiO2 (0.8% vs 0.6%), higher epinephrine levels (32 vs. 6.5 pg/mL), higher norepinephrine levels (39.4 vs 19.6 pg/mL), and lower pH (7.1 vs. 7.3). In multivariate analysis, a norepinephrine dose greater than 20 µg/min was associated with a significant 3.3-fold increased risk of death within 24 hours. Each 10% increment in FiO2 was associated with a significant 33% increased risk.
Despite these findings, the researchers concluded in a poster presentation that they were “unable to identify any specific clinical or biochemical indicators that suggested early mortality with a high degree of statistical confidence as the AUC was under 0.8.”