What are the outcomes of ICU patients with AcuTe kidnEy injury requiring Renal replacement therapy? (WATER)
CCCF ePoster library. Rai S. Oct 4, 2017; 198219; 81
Dr. Sumeet Rai
Dr. Sumeet Rai
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What are the outcomes of ICU patients with AcuTe kidnEy injury requiring Renal replacement therapy? (WATER)

Rai Sumeet; Reddy Mallikarjuna; Damodaran Vibhav; Karpe Krishna

1. Intensive Care Unit, Canberra Hospital, Garran, ACT, Australia; Australian National University Medical School, Canberra, AUSTRALIA

2. Intensive Care Unit, Frankston Hospital, Frankston, VIC, Australia

3. Australian National University Medical School, Canberra, AUSTRALIA

4. Renal Services, Canberra Hospital, Garran, ACT, Australia; Australian National University Medical School, Canberra, AUSTRALIA

Introduction: Patients admitted to the intensive care unit (ICU) with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) are known to have high short term mortality. There is scarce information on outcomes of such patients at a local level outside the context of randomized clinical trials. Local data would be invaluable for our health system to understand the extent of the burden of AKI within the community. This would inform in better prognostication and help develop evidence-based health policy, allocate health care resources and support for such patients.
Objective: To determine the long-term outcomes of ICU patients with AKI requiring CRRT at Canberra Hospital (TCH).
METHODS: Retrospective analysis of one-year outcomes of all adult patients admitted to the TCH ICU with AKI requiring CRRT from 1st July 2013 to 30th June 2015. The ICU electronic clinical information system was used to identify patients meeting inclusion criteria, obtain patient demographic data, severity of illness scores, presence of oliguric renal failure, cumulative fluid balance, characteristics of CRRT and ICU mortality. The hospital electronic record management systems and the renal database were interrogated for outcome measures like hospital and one-year mortality, ongoing need for renal replacement therapy (RRT) after ICU and hospital discharge and hospital readmissions. Patients already on RRT prior to their index ICU admission were excluded.
Primary outcomes: Hospital and one - year mortality. Secondary outcomes: Dialysis dependence and hospital readmissions in survivors.
RESULTS: The median length of ICU and hospital stay for these patients was 3 (IQR, 6 days) and 16 days (IQR, 24 days) respectively. Chronic Kidney Disease (CKD) not on any pre-existing dialysis therapy was found to be the major co-morbidity in 128/190 (67.3%) patients. Sepsis was the most common admission diagnosis in 85/190 (44.7%) patients. Hospital mortality was 37.4% (71/190) which increased to 55.6% (99/178) at one-year. At one-year, outcomes were unknown for 12/190 (6.32%) patients and hence only 178 patients were analysed. Of the survivors at one-year 5/79 patients (6.3%) were still dependent on dialysis. Predictors of one year mortality: On univariate analysis, creatinine level on ICU admission (OR 0.99, per micromol/l increase in creatinine, CI 0.99 to 1.01, p=0.015), patients who did not receive any anticoagulation for CRRT (OR 3.6, p < 0.05) and severity of illness score, Acute Physiology and Chronic Health Evaluation (APACHE II score) (OR 1.05, per one score increase, CI 1.01 to 1.09, p= 0.02) were independently associated with one-year mortality.
On multivariate analysis APACHE II score (OR, 1.06, per one unit increase in score CI 1.01, 1.09 P= 0.02) was a significant predictor.
CONCLUSIONS: Critically ill patients with AKI treated with CRRT have high one-year mortality at 55.6% at our centre. At one year, only a small proportion of survivors (6.7%) are still dependent on dialysis. However, a high proportion of survivors (39.2%) had increased healthcare utilization with ≥ 2 hospital readmissions by one-year. These outcomes appear to be consistent with other centres but remain poor for the individual patient. Future studies should prospectively assess the quality of life of survivors in this patient group, to improve patient support. 


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