WASHINGTON—Sepsis and volume overload are the most common triggers for starting continuous renal replacement therapy (CRRT) in critically ill patients, according to new study findings presented on Friday at the American Society of Nephrology’s Kidney Week 2019 meeting.
To evaluate and assess the case-mix, acuity, diagnosis, clinical course, and outcomes of patients undergoing CRRT, Oleksa G. Rewa, MD, MSc, of the University of Alberta in Canada, and colleagues employed CRRTnet, a data registry of 1226 adults (mean age 59 years; 55% male; 30% with chronic kidney disease) treated with CRRT for more than 24 hours who attended 5 academic medical centers in the United States and Canada.
Patients were most often admitted to the intensive care unit (ICU) for cardiovascular emergency (20.6%), sepsis (16.2%), surgical reasons (14.4%), respiratory failure (14.3%), liver failure (4.7%), acute abdomen problems (4.7%), acute kidney injury (AKI; 4.3%), or neurologic reasons (1.2%). With respect to illness severity, the mean Acute Physiology, Age and Chronic Health Evaluation (APACHE II) score at admission was 28.8 out of 71 and the mean Sequential Organ Failure Assessment (SOFA) score was 13.6 out of 24. Mean serum creatinine was 333.6 µmol/L. The vast majority of patients were mechanically ventilated (81.8%) and required vasopressor support (84.0%).
Acute kidney injury (AKI) most commonly occurred due to sepsis (43.8%), and to lesser extents cardiogenic causes (10.9%), hypovolemia (8.6%), hepatorenal insults (5.1%), and other reasons (17.7%). CRRT was most commonly initiated to alleviate fluid overload/edema (48.8%), oligo-anuria (14.4%), hyperkalemia (5.6%), metabolic acidosis (3.5%), and uremia (2.0%). Slightly more than half of patients on CRRT required mechanical ventilation and a similar proportion needed vasopressors.
On average, patients stayed in the ICU and hospital for 21.1 and 43.1 days, respectively. At discharge, 25.8% and 17.3% of ICU and hospital patients, respectively, required renal replacement therapy. Fifty-four percent patients died during their ICU stay, and 58% died in hospital.
“In this large multi-center prospective registry of critically ill patients treated with CRRT, the most common etiology of AKI requiring CRRT was sepsis and the most common specific indication was volume overload,” Dr Rewa told Renal & Urology News. “A substantial proportion of patients treated with CRRT were still receiving RRT at hospital discharge.
Emerging evidence is used to guide best practices and to monitor CRRT performance and delivery, Dr Rewa added. The team is working to establish a large comprehensive registry of critically ill adults receiving CRRT.
Rewa OG, Heung MH, House AA, et al. Epidemiology of patients receiving continuous renal replacement therapy: The multicenter CRRTNet Study. Presented at the American Society of Nephrology’s Kidney Week 2019 meeting held November 5-10 in Washington DC. Poster FR-PO003.