TY - JOUR
T1 - Epidemiology and Outcomes of AKI Treated With Continuous Kidney Replacement Therapy
T2 - The Multicenter CRRTnet Study
AU - Rewa, Oleksa G.
AU - Ortiz-Soriano, Victor
AU - Lambert, Joshua
AU - Kabir, Shaowli
AU - Heung, Michael
AU - House, Andrew A.
AU - Monga, Divya
AU - Juncos, Luis A.
AU - Secic, Michelle
AU - Piazza, Robin
AU - Goldstein, Stuart L.
AU - Bagshaw, Sean M.
AU - Neyra, Javier A.
N1 - Funding Information:
Funding for the study is provided by the Acute Kidney Injury Critical Care Research Foundation (AKI-CCRF, Indianapolis, Indiana, SLG President). The AKI-CCRF initially received an unrestricted grant from Gambro Renal Products, Inc (Lakewood, CO) to establish CRRTnet, which ended in 2014. Since July 2015, the AKI-CCRF received funding from Cincinnati Children's Hospital Medical Center (CCHMC) to operate CRRTnet. CCHMC receives funding from Baxter Healthcare Inc , (Deerfield, IL) through an Investigator Initiated Research grant (PI: SLG) for the express purpose of funding the AKI-CCRF’s CRRTnet activity. Neither Baxter nor its personnel had any involvement in the design of CRRTnet or the collection, analysis, and interpretation of data; writing the report; and the decision to submit the report for publication. JAN is supported by grants from NIDDK (R56 DK126930, R01DK128208, U01DK12998, and P30 DK079337). SMB is supported by a Canada Research Chair in Critical Care Outcomes and Systems Evaluation.
Publisher Copyright:
© 2023 The Authors
PY - 2023/6
Y1 - 2023/6
N2 - Rationale & Objective: Continuous kidney replacement therapy (CKRT) is the predominant form of acute kidney replacement therapy used for critically ill adult patients with acute kidney injury (AKI). Given the variability in CKRT practice, a contemporary understanding of its epidemiology is necessary to improve care delivery. Study Design: Multicenter, prospective living registry. Setting & Population: 1,106 critically ill adults with AKI requiring CKRT from December 2013 to January 2021 across 5 academic centers and 6 intensive care units. Patients with pre-existing kidney failure and those with coronavirus 2 infection were excluded. Exposure: CKRT for more than 24 hours. Outcomes: Hospital mortality, kidney recovery, and health care resource utilization. Analytical Approach: Data were collected according to preselected timepoints at intensive care unit admission and CKRT initiation and analyzed descriptively. Results: Patients’ characteristics, contributors to AKI, and CKRT indications differed among centers. Mean (standard deviation) age was 59.3 (13.9) years, 39.7% of patients were women, and median [IQR] APACHE-II (acute physiologic assessment and chronic health evaluation) score was 30 [25-34]. Overall, 41.1% of patients survived to hospital discharge. Patients that died were older (mean age 61 vs. 56.8, P < 0.001), had greater comorbidity (median Charlson score 3 [1-4] vs. 2 [1-3], P < 0.001), and higher acuity of illness (median APACHE-II score 30 [25-35] vs. 29 [24-33], P = 0.003). The most common condition predisposing to AKI was sepsis (42.6%), and the most common CKRT indications were oliguria/anuria (56.2%) and fluid overload (53.9%). Standardized mortality ratios were similar among centers. Limitations: The generalizability of these results to CKRT practices in nonacademic centers or low-and middle-income countries is limited. Conclusions: In this registry, sepsis was the major contributor to AKI and fluid management was collectively the most common CKRT indication. Significant heterogeneity in patient- and CKRT-specific characteristics was found in current practice. These data highlight the need for establishing benchmarks of CKRT delivery, performance, and patient outcomes. Data from this registry could assist with the design of such studies.
AB - Rationale & Objective: Continuous kidney replacement therapy (CKRT) is the predominant form of acute kidney replacement therapy used for critically ill adult patients with acute kidney injury (AKI). Given the variability in CKRT practice, a contemporary understanding of its epidemiology is necessary to improve care delivery. Study Design: Multicenter, prospective living registry. Setting & Population: 1,106 critically ill adults with AKI requiring CKRT from December 2013 to January 2021 across 5 academic centers and 6 intensive care units. Patients with pre-existing kidney failure and those with coronavirus 2 infection were excluded. Exposure: CKRT for more than 24 hours. Outcomes: Hospital mortality, kidney recovery, and health care resource utilization. Analytical Approach: Data were collected according to preselected timepoints at intensive care unit admission and CKRT initiation and analyzed descriptively. Results: Patients’ characteristics, contributors to AKI, and CKRT indications differed among centers. Mean (standard deviation) age was 59.3 (13.9) years, 39.7% of patients were women, and median [IQR] APACHE-II (acute physiologic assessment and chronic health evaluation) score was 30 [25-34]. Overall, 41.1% of patients survived to hospital discharge. Patients that died were older (mean age 61 vs. 56.8, P < 0.001), had greater comorbidity (median Charlson score 3 [1-4] vs. 2 [1-3], P < 0.001), and higher acuity of illness (median APACHE-II score 30 [25-35] vs. 29 [24-33], P = 0.003). The most common condition predisposing to AKI was sepsis (42.6%), and the most common CKRT indications were oliguria/anuria (56.2%) and fluid overload (53.9%). Standardized mortality ratios were similar among centers. Limitations: The generalizability of these results to CKRT practices in nonacademic centers or low-and middle-income countries is limited. Conclusions: In this registry, sepsis was the major contributor to AKI and fluid management was collectively the most common CKRT indication. Significant heterogeneity in patient- and CKRT-specific characteristics was found in current practice. These data highlight the need for establishing benchmarks of CKRT delivery, performance, and patient outcomes. Data from this registry could assist with the design of such studies.
KW - Acute kidney injury
KW - AKI
KW - CKRT
KW - continuous kidney replacement therapy
KW - continuous renal replacement therapy
KW - CRRT
KW - epidemiology
KW - intensive care unit
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U2 - 10.1016/j.xkme.2023.100641
DO - 10.1016/j.xkme.2023.100641
M3 - Article
C2 - 37274539
AN - SCOPUS:85160108983
SN - 2590-0595
VL - 5
JO - Kidney Medicine
JF - Kidney Medicine
IS - 6
M1 - 100641
ER -