Higher versus Lower Continuous Renal Replacement Therapy Intensity in Critically ill Patients with Liver Dysfunction

Area of Science:

• Nephrology
• Critical Care Medicine
• Hepatology

Background:

• Critically ill patients often develop combined acute kidney injury and liver dysfunction.
• Continuous renal replacement therapy (CRRT) is used to manage fluid balance and remove toxins in these patients.
• The optimal intensity of CRRT for this patient population remains unclear.

Purpose of the Study:

• To investigate the association between higher versus lower CRRT intensity and mortality in critically ill patients with combined acute kidney injury and liver dysfunction.
• To analyze data from the Randomized Evaluation of Normal versus Augmented Level (RENAL) trial.

Main Methods:

• Post-hoc analysis of patients with liver dysfunction (Sequential Organ Failure Assessment liver score ≥2 or diagnosis of liver failure/transplant) from the RENAL trial.
• Patients were randomized to higher intensity (40 mL/kg/h effluent flow) or lower intensity (25 mL/kg/h effluent flow) CRRT.
• Multivariable Cox regression analysis was used to assess mortality.

Main Results:

• A total of 444 patients were included; 210 received higher intensity and 234 received lower intensity CRRT.
• Mortality rates were 54.1% in the higher intensity group and 51.3% in the lower intensity group.
• Higher CRRT intensity was not independently associated with mortality (HR 0.93, 95% CI 0.70-1.24; p = 0.642).

Conclusions:

• In the RENAL trial cohort, higher CRRT intensity was not associated with reduced mortality in patients with liver dysfunction.
• These findings suggest that current CRRT intensity strategies may not significantly impact survival in this specific patient group.
• Further research may be needed to determine optimal CRRT management for critically ill patients with combined kidney and liver failure.