Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Sep 26:11:249-257.
doi: 10.2147/IJNRD.S164628. eCollection 2018.

Renal replacement therapy in patients with acute respiratory distress syndrome: a single-center retrospective study

Joshua Dill  1 , Billie Bixby  1 , Huthayfa Ateeli  1 , Benjamin Sarsah  2 , Khushboo Goel  3 , Ryan Buckley  3 , Ilya Finkelshteyn  3 , Bijin Thajudeen  2 , Pradeep V Kadambi  4 , Christian Bime  1
Affiliations

Renal replacement therapy in patients with acute respiratory distress syndrome: a single-center retrospective study

Joshua Dill et al. Int J Nephrol Renovasc Dis. .

Abstract

Background: Patients with acute respiratory distress syndrome (ARDS) who develop acute kidney injury have increased mortality and frequently require renal replacement therapy (RRT). The optimal timing for initiation of RRT after onset of ARDS to improve survival is not known.

Methods: We retrospectively reviewed clinical data on patients admitted to our health system over a 2-year period. Individual charts were carefully reviewed to ascertain that patients met the Berlin criteria for ARDS and to categorize RRT utilization. The Kaplan-Meier analysis was conducted to compare early (£48 hours postintubation) versus late (>48 hours postintubation) initiation of RRT. Associations between RRT initiation and mortality were evaluated using Cox proportional hazards regression.

Results: A total of 75 patients were identified with ARDS, 95% of whom received RRT. Mortality of patients who required RRT was 56%. The main indications for RRT initiation were fluid overload (75%), metabolic acidosis (64%), and hyperkalemia (33%). The Kaplan-Meier analysis comparing early initiation of RRT to late initiation of RRT showed no survival benefit. Cox proportional hazard models testing the association between timing of RRT initiation with survival and adjusting for sex, race, ethnicity, and Acute Physiology and Chronic Health Evaluation II score did not reach statistical significance (HR=0.94, 95% CI=0.48-1.86).

Conclusion: Timing of RRT initiation was not associated with a survival benefit. Prospective study in the utilization and outcomes of RRT in ARDS could assist in optimizing its usage in this population.

Keywords: AKI; acute respiratory distress syndrome; dialysis; intensive care; renal.

PubMed Disclaimer

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow diagram of algorithm used to select patients for chart review. Note: Any ICU bed includes medical, surgical/trauma, cardiothoracic, or cardiac care. Abbreviations: ICU, intensive care unit; BUMC, Banner University Medical Center; ESRD, end-stage renal disease; ICD, International Classification of Diseases; COPD, chronic obstructive pulmonary disorder; ARDS, acute respiratory distress syndrome; RRT, renal replacement therapy.
Figure 2
Figure 2
Number of patients who had one or more medical comorbidities on admission. Notes: x-axis represents number of comorbidities present. y-axis represents percentage of patients with each number of comorbidities.
Figure 3
Figure 3
Three indications for RRT. Note: Patients may have had one or more indications for initiation of RRT. Abbreviation: RRT, renal replacement therapy.
Figure 4
Figure 4
Time to initiation of RRT (time 0 at intubation). Notes: x-axis represents days. y-axis represents number of patients in percentage. Abbreviation: RRT, renal replacement therapy.
Figure 5
Figure 5
Kaplan–Meier survival analysis for timing of RRT initiation comparing patients who had initiated RRT £2 days (48 hours) after intubation versus >2 days after intubation. Abbreviation: RRT, renal replacement therapy.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Han F, Sun R, Ni Y, et al. Early initiation of continuous renal replacement therapy improves clinical outcomes in patients with acute respiratory distress syndrome. Am J Med Sci. 2015;349(3):199–205. - PubMed
    1. Garzia F, Todor R, Scalea T. Continuous arteriovenous hemofiltration countercurrent dialysis (CAVH-D) in acute respiratory failure (ARDS) J Trauma. 1991;31(9):1277–84. discussion 84–85. - PubMed
    1. Darmon M, Clec’h C, Adrie C, et al. Acute respiratory distress syndrome and risk of AKI among critically Ill patients. Clin J Am Soc Nephrol. 2014;9(8):1347–1353. - PMC - PubMed
    1. Seeley EJ. Updates in the management of acute lung injury: a focus on the overlap between AKI and ARDS. Adv Chronic Kidney Dis. 2013;20(1):14–20. - PubMed
    1. Wierstra BT, Kadri S, Alomar S, et al. The impact of “early” versus “late” initiation of renal replacement therapy in critical care patients with acute kidney injury: a systematic review and evidence synthesis. Crit Care. 2016;20(1):122. - PMC - PubMed