Incidence, underlying conditions, and outcomes of patients receiving acute renal replacement therapies in tertiary cardiac intensive care units: An analysis from the Critical Care Cardiology Trials Network Registry - 17/03/20
, Wayne Tymchak, MD b, Erin A. Bohula, MD, DPhil c, Jeong-Gun Park, PhD c, Lori B. Daniels, MD, MAS d, Nicholas Phreaner, MD d, Christopher F. Barnett, MD MPH e, Benjamin B Kenigsberg, MD e, Andrew DeFilippis, MD, MSc f, Narayana Sarma Singam, MD f, Gregory W. Barsness, MD g, Jacob C. Jentzer, MD g, h, Bradley Ternus, MD i, David A. Morrow, MD, MPH c, Jason N. Katz, MD, MHS jon behalf of the
Critical Care Cardiology Trials Network Investigators1
Abstract |
Background |
The prevalence of renal disease in cardiac intensive care units (CICUs) is increasing, but little is known about the utilization, concurrent therapies, and outcomes of patients requiring acute renal replacement therapy (RRT) in this specialized environment.
Methods |
In the Critical Care Cardiology Trials Network, 16 centers submitted data on CICU admissions including acute RRT (defined as continuous renal replacement therapy and/or acute intermittent dialysis).
Results |
Among 2,985 admissions, 178 (6.0%; interhospital range 1.0%-16.0%) received acute RRT. Patients receiving RRT, versus not, were more commonly admitted for cardiogenic shock (15.7% vs 4.2%, P < .01), cardiac arrest (9.6% vs 3.7%, P < .01), and acute general medical diagnoses (10.7% vs 5.8%, P < .01), whereas acute coronary syndromes (16.9% vs 32.1%, P < .01) were less frequent. Variables independently associated with acute RRT included diabetes, heart failure, liver disease, severe valvular disease, shock, cardiac arrest, hypertension, and younger age. In patients receiving acute RRT, versus not, advanced therapies including mechanical ventilation (55.6% vs 18.0%), vasoactive support (73.0% vs 35.2%), invasive hemodynamic monitoring (59.6% vs 29.2%), and mechanical circulatory support (27.5% vs 8.4%) were more common. Acute RRT was associated with higher in-hospital mortality (42.1% vs 9.3%, adjusted odds ratio 3.74, 95% CI, 2.52-5.53) and longer median length of stay (10.0 vs 5.3 days, P < .01). In conclusion, acute RRT in contemporary CICUs was associated with the provision of other advanced therapies and lower survival.
Conclusions |
These data underscore the risks associated with the provision of renal support in patients with primary cardiovascular problems and the need to develop standardized indications and potential futility measures in this specialized population.
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| Declaration of Interest: W. T.: honoraria from Bayer and consulting fees from Amgen, Bayer, and Merck. All other authors: none. |
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| Funding support: The data collection at the University of Alberta was supported by a grant from the University Hospital Foundation. The foundation had no role in the study. |
Vol 222
P. 8-14 - avril 2020 Retour au numéro
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