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. 2021 Feb;22(1):8-16.
doi: 10.1177/1751143719892792. Epub 2019 Dec 5.

The effect of timing of initiation of renal replacement therapy on mortality: A retrospective case-control study

Milo Engoren  1 , Michael D Maile  1 , Michael Heung  2 , James M Blum  3 , Ross Blank  1 , Lena M Napolitano  4 , Pauline K Park  4 , Krishnan Raghavendran  4 , Elizabeth S Jewell  1 , Craig Meldrum  4
Affiliations

The effect of timing of initiation of renal replacement therapy on mortality: A retrospective case-control study

Milo Engoren et al. J Intensive Care Soc. 2021 Feb.

Abstract

Purpose: To determine if earlier initiation of renal replacement therapy (RRT) is associated with improved survival in patients with severe acute kidney injury.

Methods: We performed a retrospective case-control study of propensity-matched groups with multivariable logistic regression using Akaike Information Criteria to adjust for non-matched variables in a surgical ICU in a tertiary care hospital.

Results: We matched 169 of 205 (82%) patients with new initiation of RRT (EARLY group) to 169 similar patients who did not initiate RRT on that day (DEFERRED group). Eighteen (11%) of DEFERRED eventually received RRT before discharge. By univariate analysis, ICU mortality was higher in EARLY (n = 60 (36%) vs. n = 23 (14%), p < 0.001) as was hospital mortality (n = 73 (43%) vs. n = 44 (26%), p = 0.001). Of the 18 RRT patients in DEFERRED, 12 (67%) died in ICU and 13 (72%) in hospital. After propensity matching and logistic regression, we found that EARLY initiation of RRT was associated with a more than doubling of ICU mortality (aOR = 2.310, 95% confidence interval = 1.254-4.257, p = 0.007). However, after similar adjustment, there was no difference in hospital mortality (aOR = 1.283, 95% CI = 0.753-2.186, p = 0.360).

Conclusions: While ICU mortality was increased in the EARLY group, there was no difference in hospital mortality between EARLY and DEFERRED groups.

Keywords: Acute kidney injury; creatinine; propensity matching; renal replacement therapy.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
(a) Box and whisker plots showing the continuous variables from the prior day used in calculating the propensity scores in the renal replacement therapy (RRT) and the no RRT group. All standardized differences were <10%. (b) Box and whisker plots showing the continuous variables from the current day used in calculating the propensity scores in the renal replacement therapy (RRT) and the no RRT group. All standardized differences were <10%.
Figure 2.
Figure 2.
Flowchart of unadjusted hospital mortality. EARLY RRT group had higher mortality than the DEFERRED group (p = 0.001), but lower mortality than the DEFERRED group who received RRT (p = 0.024). DEFERRED patients who eventually received RRT had higher mortality than DEFERRED patients who did not (p < 0.001).
Figure 3.
Figure 3.
Cox plot showing time to mortality. Timing of RRT was not associated with mortality: hazard ratio = 0.934, 95% confidence interval = 0.529–1.340, p = 0.744.
See this image and copyright information in PMC

References

    1. Susantitaphong P, Cruz DN, Cerda J, et al. World Incidence of AKI: a meta-analysis. Clin J Am Soc Nephrol 2013; 8: 1482–1493. - PMC - PubMed
    1. Bagshaw SM, George C, Bellomo R, et al. A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant 2008; 23: 1569–1574. - PubMed
    1. Wald R, McArthur E, Adhikari NK, et al. Changing incidence and outcomes following dialysis-requiring acute kidney injury among critically ill adults: a population-based cohort study. Am J Kidney Dis 2015; 65: 870–877. - PubMed
    1. Siddiqui NF, Coca SG, Devereaux PJ, et al. Secular trends in acute dialysis after elective major surgery – 1995 to 2009. CMAJ 2012; 184: 1237–1245. - PMC - PubMed
    1. Hoste EA, Schurgers M. Epidemiology of acute kidney injury: how big is the problem? Crit Care Med 2008; 36: S146–S151. - PubMed