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. 2020 Aug 18:8:63.
doi: 10.1186/s40560-020-00481-0. eCollection 2020.

Effect of renal support therapy on 5-year survival in patients discharged from the intensive care unit

Henry Oliveros  1   2 , Giancarlo Buitrago  1
Affiliations

Effect of renal support therapy on 5-year survival in patients discharged from the intensive care unit

Henry Oliveros et al. J Intensive Care. .

Abstract

Background: Between 30 and 70% of patients admitted to the intensive care unit (ICU) have acute kidney injury (AKI), and 10% of these patients will require renal replacement therapy (RRT). A significant number of studies have compared the mortality of patients who require RRT versus those who do not require it, finding an increase in mortality rates in the short and medium term; however, few studies have evaluated the long-term survival in a mixture of patients admitted to the ICU.

Objective: To evaluate the impact of RRT on 5-year survival in patients with AKI admitted to the ICU.

Methods: Using administrative databases of insurers of the Colombian health system, a cohort of patients admitted to the ICU between 1 January 2012 and 31 December 2013 was followed until 31 December 2018. ICD-10 diagnoses, procedure codes, and prescribed medications were used to establish the frequencies of the comorbidities included in the Charlson index. Patients were followed for at least 5 years to evaluate survival and establish the adjusted risks by propensity score matching.

Results: Of the 150,230 patients admitted to the ICU, 4366 (2.9%) required RRT in the ICU. Mortality rates for patients with RRT vs no RRT evaluated at ICU discharge, 1 year, and 5 years were 35%, 57.4%, and 67.9% vs 7.4%, 17.6%, and 30.1%, respectively. After propensity score matching, the hazard ratio was calculated for patients who received RRT and those who did not (HR, 2.46; 95% CI 2.37 to 2.56; p < 0.001), with a lower difference in years of survival for patients with RRT (mean effect in the treated) of - 1.86 (95% CI - 2.01 to to1.65; p < 0.001).

Conclusions: The impact of acute renal failure with the consequent need for RRT in patients admitted to the ICU is reflected in a decrease of approximately one quarter in 5-year survival, regardless of the different comorbidities.

Keywords: Acute renal failure; Critical illness; Mortality; Renal replacement therapy; Survival.

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Conflict of interest statement

Competing interestsThe authors of this manuscript have no competing interests directly related to the manuscript’s content.

Figures

Fig. 1
Fig. 1
Flowchart of included subjects based on administrative health data
Fig. 2
Fig. 2
Five-year survival curves of patients requiring RRT and not requiring RRT. Numbers of subjects 150,230, there were 50,263 failures with a rate of 7.4 events per 100 patient-years
Fig. 3
Fig. 3
Hazard ratio survival analysis on survival time from ICU admission to death
See this image and copyright information in PMC

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