Adverse events during continuous renal replacement therapy in critically ill patients: A retrospective cohort study

The objective of this study was to identify risk factors for adverse events (AEs) occurring during continuous renal replacement therapy (CRRT) in critically ill patients.

A retrospective cohort study was conducted in an intensive care unit of a private hospital in Sao Paulo, Brazil, with patients over 18 years of age, admitted between 2018 and 2023. Demographic, clinical, and AE data were analysed. Negative binomial regression was used to identify risk factors. A p value ≤0.05 was considered significant.

A total of 1.361 patients underwent CRRT, and, from these, 167 (12.2%) presented AEs. Moderate events predominated (54.5%), and pressure injuries were the most frequent type (64.2%). The majority of events occurred within the first 6 days of therapy. In the negative binomial analysis, the vasoactive drug (β: 11.18; 95% confidence interval [CI]: 9.40-12.97; p < 0.001), the presence of more than four invasive medical devices (β: 4.06; 95% CI: 2.47-5.64; p < 0.001), mechanical ventilation (β:3.52; 95% CI: 1.80-5.23; p < 0.001), male sex (β: 2.64; 95% CI: 1.49-3.79; p < 0.001), Simplified Acute Physiology Score 3 (β: 0.16; 95% CI: 0.10-0.018; p < 0.001), and age (odds ratio: 1.01; 95% CI: 0.02-0.10; p=0.002) were independently associated with increased AEs incidence.

In this cohort, the incidence of AEs during CRRT was independently associated with vasoactive drug use, mechanical ventilation, a higher invasive-device burden, male sex, a higher Simplified Acute Physiology Score 3, and older age. These findings emphasise the need for proactive surveillance and targeted interventions to improve patient safety in CRRT settings.