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
. 2023 Nov;55(11):2967-2980.
doi: 10.1007/s11255-023-03583-4. Epub 2023 Apr 7.

Associations of continuous anionic gap detection with the mortality in critically ill patients receiving renal replacement therapy

Yiling Zhai #  1   2 , Changjun Luo #  3   4 , Tao Zhou  5   4 , Guangzhi Zeng  6 , Qiongyan Huang  7 , Jun Li  3
Affiliations

Associations of continuous anionic gap detection with the mortality in critically ill patients receiving renal replacement therapy

Yiling Zhai et al. Int Urol Nephrol. 2023 Nov.

Abstract

Purpose: To investigate the associations of anion gap (AG) levels before and 1-day after hemodialysis as well as anion gap changes with the mortality in critically ill patients receiving renal replacement therapy (RRT).

Methods: Totally, 637 patients from MIMIC-III were included in this cohort study. The associations between AG (T0), AG (T1), or ∆AG [AG (T0) - AG (T1)], and the risk of 30-day or 1-year mortality were examined by Cox restricted cubic spline regression models. Univariate and multivariate Cox proportional-hazards model was applied to assess the associations between AG (T0), AG (T1), ∆AG with 30-day and 1-year mortality, respectively.

Results: The median follow-up time was 18.60 (8.53, 38.16) days and 263 (41.3%) patients were survived. There was a linear relationship between AG (T0), AG (T1) or ∆AG and the risk of 30-day or 1-year mortality, respectively. The risk of 30-day mortality was higher in AG (T0) > 21 group (HR = 1.723, 95% CI 1.263-2.350), and AG (T1) > 22.3 group (HR = 2.011, 95% CI 1.417-2.853), while lower in AG > 0 group (HR = 0.664, 95% CI 0.486-0.907). The risk of 1-year mortality was increased in AG (T0) > 21 group (HR = 1.666, 95% CI 1.310-2.119), and AG (T1) > 22.3 group (HR = 1.546, 95% CI 1.159-2.064), while decreased in AG > 0 group (HR = 0.765, 95% CI 0.596-0.981). Patients with AG (T0) ≤ 21 had higher 30-day and 1-year survival probability than those with AG (T0) > 21.

Conclusion: AG before and after dialysis as well as the changes of AG were important factors associated with the risk of 30-day and 1-year mortality in critically ill patients receiving RRT.

Keywords: Dialysis; Renal replacement therapy; Serum anion gap; ∆AG.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no conflict of interest exists.

Figures

Fig. 1
Fig. 1
The screen process of the participants
Fig. 2
Fig. 2
The Cox regression model with a restricted cubic spline showing a linear relationship between AG (T0) and the risk of 30-day mortality in the patients
Fig. 3
Fig. 3
The Cox regression model with a restricted cubic spline showing a linear relationship between AG (T0) and the risk of 1-year mortality in the patients
Fig. 4
Fig. 4
The Cox regression model with a restricted cubic spline showing a linear relationship between AG (T1) and the risk of 30-day mortality in the patients
Fig. 5
Fig. 5
The Cox regression model with a restricted cubic spline showing a linear relationship between AG (T1) and the risk of 1-year mortality in the patients
Fig. 6
Fig. 6
The Cox regression model with a restricted cubic spline showing a linear relationship between ∆AG and the risk of 30-day mortality in the patients
Fig. 7
Fig. 7
The Cox regression model with a restricted cubic spline showing a linear relationship between ∆AG and the risk of 1-year mortality in the patients
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Kim KY, Ryu JH, Kang DH, Kim SJ, Choi KB, Lee S. Early fluid management affects short-term mortality in patients with end-stage kidney disease undergoing chronic hemodialysis and requiring continuous renal replacement therapy. BMC Nephrol. 2022;23(1):102. doi: 10.1186/s12882-022-02725-7. - DOI - PMC - PubMed
    1. Naorungroj T, Neto AS, Yanase F, Eastwood G, Wald R, Bagshaw SM, Bellomo R. Time to initiation of renal replacement therapy among critically ill patients with acute kidney injury: a current systematic review and meta-analysis. Crit Care Med. 2021;49(8):e781–e792. doi: 10.1097/ccm.0000000000005018. - DOI - PubMed
    1. Chappell K, Kimmons LA, Haller JT, Canada RB, He H, Hudson JQ. Levetiracetam pharmacokinetics in critically ill patients undergoing renal replacement therapy. J Crit Care. 2021;61:216–220. doi: 10.1016/j.jcrc.2020.10.032. - DOI - PubMed
    1. Chaijamorn W, Rungkitwattanakul D, Pattharachayakul S, Singhan W, Charoensareerat T, Srisawat N. Meropenem dosing recommendations for critically ill patients receiving continuous renal replacement therapy. J Crit Care. 2020;60:285–289. doi: 10.1016/j.jcrc.2020.09.001. - DOI - PubMed
    1. Woodward CW, Lambert J, Ortiz-Soriano V, Li Y, Ruiz-Conejo M, Bissell BD, Kelly A, Adams P, Yessayan L, Morris PE, Neyra JA. Fluid overload associates with major adverse kidney events in critically ill patients with acute kidney injury requiring continuous renal replacement therapy. Crit Care Med. 2019;47(9):e753–e760. doi: 10.1097/ccm.0000000000003862. - DOI - PubMed

LinkOut - more resources