Factors associated with poor outcomes of continuous renal replacement therapy
Journal
PLoS ONE
Journal Volume
12
Journal Issue
5
Pages
e0177759
Date Issued
2017
Author(s)
Abstract
Continuous renal replacement therapy (CRRT) is one of the dialysis modalities for critically ill patients. Despite intensive dialysis care, a high mortality rate is found in these patients. Our objective was to investigate the factors associated with poor outcomes in these patients. We conducted a retrospective cohort study using the National Health Insurance Research Database. Records of critically ill patients who received CRRT between 2007 and 2011 were retrieved, and the patients were categorized into two groups: those with acute kidney injury (AKI) and those with history of end-stage renal disease (ESRD). Our primary and secondary outcomes were in-hospital mortality and long-term survival and non-renal recovery (long-term dialysis dependence), respectively, in the AKI group. We enrolled 15,453 patients, with 13,204 and 2249 in the AKI and ESRD groups, respectively. Overall, 66.5% patients died during hospitalization. In-hospital mortality did not differ significantly between groups (adjusted odds ratio, 0.93; 95% CI, 0.84-1.02). Age, chronic liver disease, and cancer history were identified as independent risk factors for in-hospital mortality in both groups. Hypertension was associated with higher risk of in-hospital mortality in patients with AKI. Age, coronary artery disease, and admission to the medical intensive care unit (MICU) were risk factors for long-term dialysis dependence in patients with AKI. Patients with AKI and ESRD have similarly poor outcomes after CRRT. Older age and presence of chronic liver disease and cancer were associated with higher mortality. Older age, presence of coronary artery disease, and admission to MICU were associated with lower renal recovery rate in patients with AKI. ? 2017 Kao et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
SDGs
Other Subjects
acute kidney failure; age; aged; Article; chronic liver disease; chronic obstructive lung disease; cohort analysis; congestive heart failure; continuous renal replacement therapy; convalescence; coronary artery disease; critically ill patient; diabetes mellitus; disease association; end stage renal disease; female; hospital admission; hospital mortality; human; hypertension; long term survival; major clinical study; male; malignant neoplasm; medical history; medical intensive care unit; peripheral vascular disease; population research; retrospective study; risk factor; Taiwan; treatment outcome; Acute Kidney Injury; adult; adverse effects; critical illness; epidemiology; hemodialysis; intensive care unit; Kaplan Meier method; Kidney Failure, Chronic; middle aged; mortality; procedures; treatment outcome; very elderly; young adult; Acute Kidney Injury; Adult; Aged; Aged, 80 and over; Cohort Studies; Critical Illness; Female; Hospital Mortality; Humans; Intensive Care Units; Kaplan-Meier Estimate; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis; Retrospective Studies; Risk Factors; Taiwan; Treatment Outcome; Young Adult
Publisher
Public Library of Science
Type
journal article