Inter-hospital transfers and outcomes of critically ill patients with severe acute kidney injury: a multicentre cohort study

Abstract

Introduction: Patients with severe acute kidney injury (AKI) who are hospitalized at centers that do not provide renal replacement therapy (RRT) are frequently subjected to inter-hospital transfer for the provision of RRT. It is unclear whether such transfers are associated with worse patient outcomes as compared with the receipt of initial care in a center that provides RRT. This study examined the relationship between inter-hospital transfer and 30-day mortality among critically ill patients with AKI who received RRT. Methods: We conducted a retrospective cohort study of all critically ill patients who commenced RRT for AKI at two academic hospitals in Toronto, Canada. The exposure of interest was inter-hospital transfer for the administration of RRT. We evaluated the relationship between transfer status and 30-day mortality (primary outcome) and RRT dependence at 30 days following RRT initiation (secondary outcome), by using multivariate logistic regression with adjustment for patient demographics, clinical factors, biochemical indices, and severity of illness.

Outcomes of Ventilated Patients With Sepsis Who Undergo Interhospital Transfer: A Nationwide Linked Analysis*

“…The risk-benefit ratio appears to strongly favor transfer for some conditions, such as the acute coronary syndrome (ACS) and trauma; in these cases, specific interventions at the receiving hospital appear to have a benefit (4–9). However, the calculus is less clear (and often remains to be studied) for many others (12, 13, 27).…”

“…The assumption has been that IHT of critically ill patients will result in improved outcomes, and that the risks and costs of transportation are outweighed by the benefits (1–3). The risk-benefit ratio appears to strongly favor transfer for some conditions, such as acute coronary syndrome, stroke, and trauma (4–11), but the ratio is less clear (and often remains to be studied) for many others (12, 13). IHT has been shown to cause delays in administering timely treatments for sepsis, and there is recent concern that IHT could be a vector for nosocomial pathogens(14, 15).…”