A Single-Center Review of Renal Replacement Therapy in Patients With Acute Traumatic Brain Injury

Traumatic brain injury (TBI) is a major cause of morbidity, and concomitant acute kidney injury presents substantial management challenges. Continuous renal replacement therapy (CRRT) is thought to cause less hemodynamic instability than intermittent hemodialysis (IHD) after TBI, but factors associated with modality selection in TBI remain unclear. We sought to describe the clinical characteristics and outcomes of patients with TBI requiring renal replacement therapy and to test whether injury severity, Glasgow Coma Scale (GCS), and comorbidity burden were associated with the receipt of CRRT vs. IHD.

This 10-year retrospective study at a level I trauma center included adult TBI patients requiring renal replacement therapy. Patients were grouped by modality (CRRT vs. IHD), and demographics, injury severity, and outcome variables were compared.

Eighty-one patients met the inclusion criteria; 52 received IHD and 29 received CRRT. Patients receiving IHD were older (69 vs. 58 years, p=0.006) and had higher Charlson Comorbidity Index scores (6.6 vs. 3.5, p<0.001). Patients receiving CRRT had lower presenting GCS (8.7 vs. 13.5, p<0.001) and higher injury severity scores (24.5 vs. 16.2, p=0.006). CRRT patients had higher mortality (62.1% vs. 30.8%, p<0.001), longer hospital stays (17 vs. 8.6 days, p=0.001), and were more commonly discharged with severe disability (17.2% vs. 3.8%, p=0.001).

In this retrospective cohort, we found that CRRT was more frequently used in TBI patients with worse injuries and lower levels of consciousness on presentation, whereas patients with greater comorbid burden were more likely to receive IHD. These findings highlight the need for evidence-based guidelines to inform renal replacement modality selection in acute TBI.