Early mortality on continuous renal replacement therapy (CRRT): the prairie CRRT study

Area of Science:

• Critical Care Medicine
• Nephrology
• Intensive Care Unit Management

Background:

• Patients with acute kidney injury (AKI) requiring renal replacement therapy (RRT) have elevated short- and long-term mortality risks.
• Continuous renal replacement therapy (CRRT) is standard care for AKI in North American ICUs.

Purpose of the Study:

• To identify clinical and demographic factors associated with mortality within 24 hours of initiating CRRT.
• To investigate predictors of early mortality in critically ill AKI patients undergoing CRRT.

Main Methods:

• Prospective cohort study conducted in three ICUs in Saskatchewan, Canada.
• Analysis of 106 AKI patients initiated on CRRT between April 2013 and September 2014.
• Stepwise multivariate logistic regression used to identify independent predictors of 24-hour mortality.

Main Results:

• Of 106 patients on CRRT, 66 died in the ICU; 17 (26%) died within 24 hours of CRRT initiation.
• Univariate analysis identified high fraction of inspired oxygen (FiO2), and high-dose epinephrine, vasopressin, and norepinephrine as associated with early mortality.
• Multivariate analysis revealed only FiO2 and high-dose norepinephrine (>20 μg/min) were independently associated with mortality within 24 hours.

Conclusions:

• Patients with AKI requiring CRRT have a significant risk of early mortality.
• Hypoxia (elevated FiO2) and vasopressor use (specifically high-dose norepinephrine) are independent predictors of adverse short-term survival in this population.