Long-term survival of chronic dialysis patients following survival from an episode of multiple-organ failure

Chapman, Richard; Templeton, Maie; Ashworth, Simon; Broomhead, R; McLean, A.G.; Brett, Stephen

doi:10.1186/cc7867

Cited by 21 publications

(40 citation statements)

References 15 publications

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“…Other studies have reported ICU mortality rates of 9% to 44% for chronic dialysis patients [4, 5, 7, 8, 10–15, 18–20]. …”

Section: Short-term Outcomesmentioning

confidence: 99%

“…This significant increase in mortality is however not surprising, given the higher illness severity scores of ESRD patients on admission to ICU in this study. In 199 dialysis-dependent patients requiring support of two or more organ systems (including RRT), ICU mortality was 44% [18], a figure similar to ICU mortality for patients with multiorgan failure which can range from 20% to 95% depending on the number of organs involved and underlying comorbidity. …”

Section: Short-term Outcomesmentioning

confidence: 99%

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Outcomes of Chronic Hemodialysis Patients in the Intensive Care Unit

Chan

Ostermann

2013

Critical Care Research and Practice

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Patients with end-stage renal disease (ESRD) experience higher rates of hospitalisation, cardiovascular events, and all-cause mortality and are more likely to require admission to the intensive care unit (ICU) than patients with normal renal function. Sepsis and cardiovascular diseases are the most common reasons for ICU admission. ICU mortality rates in patients requiring chronic hemodialysis are significantly higher than for patients without ESRD; however, dialysis patients have a better ICU outcome than those with acute kidney injury (AKI) requiring renal replacement therapy suggesting that factors other than loss of renal function contribute to their prognosis. Current evidence suggests, the longer-term outcomes after discharge from ICU may be favourable and that long-term dependence on dialysis should not prejudice against prompt referral or admission to ICU.

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“…Other studies have reported ICU mortality rates of 9% to 44% for chronic dialysis patients [4, 5, 7, 8, 10–15, 18–20]. …”

Section: Short-term Outcomesmentioning

confidence: 99%

Section: Short-term Outcomesmentioning

confidence: 99%

Outcomes of Chronic Hemodialysis Patients in the Intensive Care Unit

Chan

Ostermann

2013

Critical Care Research and Practice

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“…While studies that have evaluated the impact of ICU admission on the long-term survival of dialysis patients beyond 6 months report conflicting results [8,9,20,21], overall, ESRD patients who survive past hospital discharge appear to have outcomes comparable to those of the general dialysis population.…”

Section: Epidemiology Of Critical Illness In Dialysis Patientsmentioning

confidence: 99%

“…Chapman et al [20] reported that 62 (56%) of the dialysis patients who survived past ICU discharge were alive at 2 years. When the deaths that occurred 1 month after ICU discharge were eliminated, the difference between the group of dialysis patients with an episode of critical illness and registry controls was no longer significant; the majority of these early deaths occurred in hospital.…”

Section: Epidemiology Of Critical Illness In Dialysis Patientsmentioning

confidence: 99%

Renal Replacement Therapy in the End-Stage Renal Disease Patient with Critical Illness

Thompson¹,

Pannu

2012

Blood Purif

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Dialysis patients account for 1–9% of all intensive care unit (ICU) admissions. As a result of the increasing prevalence of patients with end-stage renal disease (ESRD) and the changing demographics of this population, the number of dialysis patients requiring hospitalization and ICU support is expected to increase. Critically ill ESRD patients have more comorbidity and higher severity of illness than the general population resulting in higher ICU and in-hospital mortality rates. ESRD patients have been excluded from trials evaluating renal replacement therapy in the ICU, therefore little information is available about the optimal management of renal replacement therapy for dialysis patients in this setting. This review focuses on the epidemiology of chronic dialysis patients admitted to the ICU and discusses an approach to providing renal replacement therapy for critically ill patients with ESRD.

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“…This situation has cumulated in a rise in critical illness and the need for admission to the intensive care unit (ICU) (5)(6)(7). Despite this escalation in ICU admission, little literature is available about the causes of critical illness, prognosis, or long-term outcomes to guide health care providers (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”

mentioning

confidence: 99%

High Rates of Mortality and Technique Failure in Peritoneal Dialysis Patients after Critical Illness

Khan¹,

Rigatto

Verrelli

et al. 2012

Perit Dial Int

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♦ Introduction: Little is known regarding the causes and outcomes of peritoneal dialysis (PD) patients admitted to the intensive care unit (ICU). We explored the outcomes of technique failure and mortality in a cohort of PD patients admitted to the ICU. ♦ Methods: Using a provincial database of 990 incident PD patients followed from January 1997 to June 2009, we identified 90 (9%) who were admitted to the ICU. Parametric and nonparametric tests were used as appropriate to determine differences in baseline characteristics. The Cox proportional hazards and competing risk methods were used to investigate associations. ♦ Results: Compared with other patients, those admitted to the ICU had been on PD longer (p < 0.0001) and were more often on continuous ambulatory PD (74.2% vs 25.8%, p = 0.016). Cardiac problems were the most common admitting diagnosis (50%), followed by sepsis (23%), with peritonitis accounting for 69% of the sepsis admissions. The 1-year mortality was 53.3%, with 12% alive and converted to hemodialysis, and one third remaining alive on PD. A s the steady worldwide rise in the peritoneal dialysis (PD) population continues, the requirements for and health resources consumed by this population rise in parallel. Today, PD patients are increasingly older, with lower functional status and a higher burden of comorbid illness (1-4). This situation has cumulated in a rise in critical illness and the need for admission to the intensive care unit (ICU) (5-7). Despite this escalation in ICU admission, little literature is available about the causes of critical illness, prognosis, or long-term outcomes to guide health care providers (8-18).The existing data seem to suggest that, in the dialysis population, admission to the ICU portends a poor prognosis. However, the situation is seemingly more complicated, because after accounting for comorbid illnesses and illness acuity upon admission to the ICU, end-stage renal disease (ESRD) patients have outcomes similar to those for non-ESRD patients. This suggests that ESRD is not per se responsible for an increase in poor outcomes such as death and length of ICU stay (5,6).To our knowledge, few studies have directly addressed the impact of dialysis modality on critical illness. One small study included 92 ESRD patients, 16 of whom were on PD (12). The PD patients experienced poor survival, having a 44% mortality compared with 25% in the hemodialysis (HD) cohort. Recent data collected by our group further strengthens the finding that dialysis modality may play a strong role in survival (19). Our group analyzed the long-term outcomes of 619 ESRD patients, 95 of whom were on PD; 334, on HD with a catheter; and 190, on HD with an arteriovenous fistula. Three different models accounting for case mix, comorbid illness, and physiologic variables found, as expected, that compared with HD patients having an arteriovenous fistula, HD patients with a catheter had an adjusted hazard ratio (HR) for death ranging from 1.50 to 1.58. What was unexpected and surprising was we also obser...

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Long-term survival of chronic dialysis patients following survival from an episode of multiple-organ failure

Abstract: Introduction This study aimed to examine the long-term outcome for patients with end-stage renal failure (ESRF) who survived multiple-organ failure.

Cited by 21 publications

References 15 publications

Outcomes of Chronic Hemodialysis Patients in the Intensive Care Unit

Outcomes of Chronic Hemodialysis Patients in the Intensive Care Unit

Renal Replacement Therapy in the End-Stage Renal Disease Patient with Critical Illness

High Rates of Mortality and Technique Failure in Peritoneal Dialysis Patients after Critical Illness

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