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Comparative Study
. 2010;14(6):R221.
doi: 10.1186/cc9355. Epub 2010 Dec 1.

Renal replacement therapy is an independent risk factor for mortality in critically ill patients with acute kidney injury

Monique M Elseviers  1 , Robert L Lins, Patricia Van der Niepen, Eric Hoste, Manu L Malbrain, Pierre Damas, Jacques Devriendt; SHARF investigators
Collaborators, Affiliations
Comparative Study

Renal replacement therapy is an independent risk factor for mortality in critically ill patients with acute kidney injury

Monique M Elseviers et al. Crit Care. 2010.

Abstract

Introduction: Outcome studies in patients with acute kidney injury (AKI) have focused on differences between modalities of renal replacement therapy (RRT). The outcome of conservative treatment, however, has never been compared with RRT.

Methods: Nine Belgian intensive care units (ICUs) included all adult patients consecutively admitted with serum creatinine >2 mg/dl. Included treatment options were conservative treatment and intermittent or continuous RRT. Disease severity was determined using the Stuivenberg Hospital Acute Renal Failure (SHARF) score. Outcome parameters studied were mortality, hospital length of stay and renal recovery at hospital discharge.

Results: Out of 1,303 included patients, 650 required RRT (58% intermittent, 42% continuous RRT). Overall results showed a higher mortality (43% versus 58%) as well as a longer ICU and hospital stay in RRT patients compared to conservative treatment. Using the SHARF score for adjustment of disease severity, an increased risk of death for RRT compared to conservative treatment of RR = 1.75 (95% CI: 1.4 to 2.3) was found. Additional correction for other severity parameters (Acute Physiology And Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA)), age, type of AKI and clinical conditions confirmed the higher mortality in the RRT group.

Conclusions: The SHARF study showed that the higher mortality expected in AKI patients receiving RRT versus conservative treatment can not only be explained by a higher disease severity in the RRT group, even after multiple corrections. A more critical approach to the need for RRT in AKI patients seems to be warranted.

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Figures

Figure 1
Figure 1
Assignment to different treatment modalities within each SHARF score class. CRRT, continuous renal replacement therapy; IRRT, intermittent renal replacement therapy.
Figure 2
Figure 2
Outcome in patients with conservative treatment and renal replacement therapy. LOS, length of stay; RRT, renal replacement therapy.
Figure 3
Figure 3
Risk of mortality in patients with conservative treatment and renal replacement therapy. Binary logistic regression analysis with 'without RRT' as reference category, controlled for disease severity using the SHARF score. A. Predefined subgroup analysis. B. Exclusion of possible confounders. AKI, acute kidney injury; ICU, intensive care unit; RRT, renal replacement therapy; RR (CI 95%), relative risk with 95% confidence interval.
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Comment in

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