Outcomes of patients on chronic kidney replacement therapy admitted to intensive care unit

Patients receiving chronic kidney replacement therapy (cKRT) are at high risk of admission to the intensive care unit (ICU), where their management remains challenging. Short- and long-term outcomes of cKRT patients admitted to ICU remain elusive precluding optimization of ICU admission policies and dedicated follow-up after discharge.

In this retrospective study of 216 cKRT patients admitted to a tertiary ICU in France (2013-2021), multivariable logistic regression and Cox's proportional hazard models were employed to identify predictive factors of death in ICU, at one year, and at long-term.

The leading cause of admission were septic shock (36.1%). The mortality rate in ICU was 14.5% and was best predicted by cardiac arrest as the cause of admission, the SAPS2, the need of mechanical ventilation, and the use of a tunneled catheter for dialysis access, while 1-year survival was predicted by age, RBC transfusion and the SAPS-2 score. Median survival in ICU survivors was 49 months. In survivors, long-term mortality was predicted by the number of daily medications before the admission (HR 1.089 (CI_95% 1.027; 1.155)), the use of a tunneled catheter (HR 1.67 (CI_95% 1.06; 2.7)), and age at admission (HR 1.036 (CI_95% 1.017; 1.057)). During the 6 months following discharge from the ICU, 125 patients (69%) were re-admitted to the hospital. Finally, twenty-one patients received a kidney transplant.

The prediction of early death in cKRT patients admitted to ICU largely depends on the severity of the acute condition at admission, whereas a multimodal risk stratification including surrogate markers of frailty gives a better indication of long-term outcomes.