Epidemiology of Acute Renal Failure in ICUs: A Multi-Center Prospective Study

Andrikos, Emilios; Tseke, Paraskevi; Balafa, Olga; Cruz, Dinna N.; Tsinta, Afrodite; Androulaki, Marianthi; Pappas, M.; Ronco, Claudio

doi:10.1159/000231986

Cited by 43 publications

(29 citation statements)

References 66 publications

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“…However, our findings (19) are different from those of Wald et al (4) as well as many of the previous observational studies (1,(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50). Instead, our findings are more consistent with previous RCTs (1,15,16,(30)(31)(32)51,52).…”

Section: Discussioncontrasting

confidence: 99%

“…However, several of these trials had limitations, including small sample sizes, inability to control for major clinical decisions, and inability to control for other supportive management strategies that affect outcomes in AKI (e.g., nutrition support, hemodynamic support, timing of initiation of RRT, and dose of dialysis) (4,25,27). Previous observational studies have suggested that initial modality of RRT may affect renal recovery in AKI, with a higher rate of dialysis dependence seen among survivors who initially received IHD versus CRRT (1,4,(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50). These discrepant findings could be caused by inherent biases in observational studies that are not present in RCTs, such as imbalances between groups and differential mortality rates.…”

Section: Discussionmentioning

confidence: 99%

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Modality of RRT and Recovery of Kidney Function after AKI in Patients Surviving to Hospital Discharge

Liang

Sileanu

Clermont

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives Observational evidence has suggested that RRT modality may affect recovery after AKI. It is unclear whether initial choice of intermittent hemodialysis or continuous RRT affects renal recovery, survival, or development of ESRD in critically ill patients when modality choice is made primarily on hemodynamics.Design, setting, participants, & measurements We performed a retrospective cohort study examining adults ($18 years old) admitted to intensive care units from 2000 to 2008 who received RRT for AKI and survived to hospital discharge or 90 days. We analyzed renal recovery (alive and not requiring RRT) and reasons for nonrecovery (death or ESRD) at 90 and 365 days. Conditional multivariable logistic regression was used to assess differences in renal recovery at 90 and 365 days between continuous RRT and intermittent hemodialysis. Models were stratified by propensity for continuous RRT and adjusted for age and reference creatinine.Results Of 4738 patients with Kidney Disease Improving Global Outcomes stage 3 AKI, 1338 (28.2%) received RRT, and 638 (47.7%) survived to hospital discharge (353 intermittent hemodialysis and 285 continuous RRT). Recovery from AKI was lower for intermittent hemodialysis versus continuous RRT at 90 days (66.6% intermittent hemodialysis versus 75.4% continuous RRT; P=0.02) but similar at 365 days (54.1% intermittent hemodialysis versus 59.6% continuous RRT; P=0.17). In multivariable analysis, there was no difference in odds of recovery at 90 or 365 days for patients initially treated with continuous RRT versus intermittent hemodialysis (90 days: odds ratio, 1.19; 95% confidence interval, 0.91 to 1.55; P=0.20; 365 days: odds ratio, 0.93; 95% confidence interval, 0.72 to 1.2; P=0.55).Conclusions We found no significant difference in hazards for nonrecovery or reasons for nonrecovery (mortality or ESRD) with intermittent hemodialysis versus continuous RRT. These results suggest that, when initial RRT modality is chosen primarily on hemodynamics, renal recovery and clinical outcomes in survivors are similar between intermittent hemodialysis and continuous RRT.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Modality of RRT and Recovery of Kidney Function after AKI in Patients Surviving to Hospital Discharge

Liang

Sileanu

Clermont

et al. 2016

Clinical Journal of the American Society of Nephrology

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“…[1][2][3] AKI is especially common in critically ill patients in the intensive care unit (ICU) and occurs in up to 67% of ICU admissions, depending on the definition used. [4][5][6] Five to six percent of patients with AKI in the ICU require renal replacement therapy (RRT). 5,7 AKI requiring RRT is associated with a very high mortality rate ranging from 50 to 83%.…”

Section: Introductionmentioning

confidence: 99%

In Critically Ill Patients Requiring CRRT, AKI Is Associated with Increased Respiratory Failure and Death Versus ESRD

et al. 2011

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Background/aims: To compare outcomes of critically ill patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) versus those with pre-existing end-stage renal disease (ESRD) requiring CRRT to identify factors that contribute to the increased mortality seen in AKI patients. Methods: Retrospective cohort of 257 intensive care unit (ICU) patients who received CRRT. AKI is defined as requiring CRRT with an admission serum creatinine ≤1 mg/dL; ESRD is defined as chronic dialysis dependence. Primary outcome was hospital mortality. Multivariate logistic regression was performed to determine the impact of APACHE II score, intubation, vasopressors, infection, diabetes, hypertension, gender, and race on mortality. Results: Of 257 patients requiring CRRT, 28 had ESRD and 108 had AKI. Hospital mortality was higher in patients with AKI versus ESRD (69% vs. 39%, p = 0.0032). Severity of illness using APACHE II was similar in AKI and ESRD. Patients with AKI were more likely to require mechanical ventilation (89% vs. 57%, p = 0.0003). After multivariate analysis, the requirement for mechanical ventilation was the single factor associated with increased hospital mortality [odds ratio (OR): 3.1]. Conclusions: In ICU patients requiring CRRT, patients with AKI have a higher mortality than patients with ESRD due to an increased need for mechanical ventilation.

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“…Severe sepsis and septic shock are life-threatening complications of infections [1] and are the most common causes of death in intensive care units [2][3][4] . The high morbidity and mortality rates associated with sepsis urgently call for novel therapies.…”

Section: Endothelial Bioreactor Ameliorates Endotoxemia Sepsis In Swinementioning

confidence: 99%

Endothelial Bioreactor Ameliorates Endotoxemia Sepsis in Swine

Xie

Liu

et al. 2009

Blood Purif

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Introduction: Severe sepsis involves a complex response including the activation of lots of cells, inflammatory mediators, and the hemostatic system. Central to this process is an alteration of endothelial cell function. Therefore, we investigated whether an endothelial bioreactor (EBR) would provide a new therapeutic approach to this clinical disorder. Methods: EBR was constructed using a cartridge which contained with nonwoven polytetrafluoroethylene seeded with porcine iliac artery endothelial cell (PIEC). Pigs were intravenously administered with 0.25 mg/kg lipopolysaccharide and immediately placed in an extracorporeal circuit with EBR or sham controls. Results: Compared with the sham group, EBR therapy resulted in significantly higher mean arterial blood pressure and significantly lower plasma von Willebrand factor, endothelin-1 and scores of lung injury. These alterations were associated with a significant survival advantage in the EBR group. Conclusions: Timely intervention with EC therapy in a tissue-engineered bioreactor may improve cardiovascular performance and alter the natural history of endotoxemia sepsis.

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Epidemiology of Acute Renal Failure in ICUs: A Multi-Center Prospective Study

Cited by 43 publications

References 66 publications

Modality of RRT and Recovery of Kidney Function after AKI in Patients Surviving to Hospital Discharge

Modality of RRT and Recovery of Kidney Function after AKI in Patients Surviving to Hospital Discharge

In Critically Ill Patients Requiring CRRT, AKI Is Associated with Increased Respiratory Failure and Death Versus ESRD

Endothelial Bioreactor Ameliorates Endotoxemia Sepsis in Swine

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