Overview of Renal Replacement Therapy Use in a General Intensive Care Unit

Abstract

Objectives. Population-based studies regarding renal replacement therapy (RRT) used in critical care populations are useful to understand the trend and impact of medical care interventions. We describe the use of RRT and associated outcomes (mortality and length of intensive care stay) in a level 1 hospital. Design. A retrospective descriptive observational study. Patients. Critically ill patients admitted to the ICU from 1 January to 31 December 2018. Interventions. Age, gender, ward of admission, primary organ dysfunction at admission, length of hospital stay (LOS), mechanical ventilation, APACHE, SOFA and ISS scores, the use of vasopressors, transfusion, RRT and the number of RRT sessions were extracted. Results. 1703 critically ill patients were divided into two groups: the RRT-group (238 patients) and the non-RRT group (1465 patients). The mean age was 63.58 ± 17.52 (SD) in the final ICU studied patients (64.72 ± 16.64 SD in the RRT-group), 60.5% being male. Patients admitted from general surgery ward needing RRT were 41.4%. The specific scores, the use of vasopressors, transfusions and mortality were higher in the RRT-group. The ICU LOS was superior in the RRT-group, regardless of the primary organ dysfunction. Conclusions. RRT was practiced in 13.9% of patients (especially after age of 61), with mortality being the outcome for 66.8% of the RRT-group patients. All analyzed data were higher in the RRT group, especially for multiple trauma and surgical patients, or patients presenting cardiac or renal dysfunctions at admission. We found significant increased ISS scores in the RRT-group, a significant association between the need of vasopressors or transfusion requirement and RRT use, and an association in the number of RRT sessions and LOS (p < 0.001).

APRICOT-Mamba: Acuity Prediction in Intensive Care Unit (ICU): Development and Validation of a Stability, Transitions, and Life Sustaining Therapies Prediction Model

“…A significant number of patients in the ICU require MV, with an incidence rate of 20-40% [1], while 30-50% of ICU patients require BT [13]. Vasopressors (VP) are used to manage blood pressure in about 27% of ICU patients [14], and CRRT is needed in patients with chronic kidney disease or acute kidney injury, up to 14% of ICU patients [15]. Ren et al considered patients unstable if they required at least one of the four life-supportive therapies (MV, BT, VP, CRRT); if not, they were considered stable.…”

Vancomycin dosing in high‐intensity continuous renal replacement therapy: A retrospective cohort study

“…The frequency of this occurring is not well established, but it is estimated that up to 20% of patients in the ICU may require renal replacement therapy. 4 When dialysis is indicated, continuous renal replacement therapy (CRRT) may be favored over intermittent hemodialysis (iHD) as it minimizes fluid and osmotic shifts, which can precipitate or worsen hemodynamic instability, while still providing necessary metabolic clearance and volume removal. 5,6 Although CRRT is often indicated, it has been shown to be an independent risk factor for mortality in patients with sepsis.…”

“…Despite acute interventions (e.g., volume expansion, removal of nephrotoxic agents, blood pressure support, relief of potential obstruction, trial of diuresis), many patients in critical care who were not already dialysis‐dependent progress into oliguric AKI necessitating renal replacement therapy. The frequency of this occurring is not well established, but it is estimated that up to 20% of patients in the ICU may require renal replacement therapy 4 . When dialysis is indicated, continuous renal replacement therapy (CRRT) may be favored over intermittent hemodialysis (iHD) as it minimizes fluid and osmotic shifts, which can precipitate or worsen hemodynamic instability, while still providing necessary metabolic clearance and volume removal 5,6 .…”