Association between Continuous Kidney Replacement Therapy Intensity and Mortality in Critically Ill Patients: A...

Area of Science:

• Nephrology
• Critical Care Medicine
• Extracorporeal Therapies

Background:

• Continuous kidney replacement therapy (CKRT) is vital for critically ill patients with unstable hemodynamics.
• Current Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend a CKRT dose of 20-25 mL/kg/h.
• The impact of CKRT intensity on mortality in these patients requires further clarification.

Purpose of the Study:

• To investigate the association between different intensities of delivered CKRT and 90-day mortality.
• To evaluate the optimal CKRT dosing strategy for critically ill patients.

Main Methods:

• Retrospective analysis of 2,265 patients from the MIMIC-IV database.
• Patients were categorized by CKRT dose: low (<20 mL/kg/h), moderate (20-25 mL/kg/h), and high (>25 mL/kg/h).
• Cox regression with propensity score weighting and restricted cubic splines assessed mortality risk and dose-response relationships.

Main Results:

• Low-intensity (HR=0.62) and moderate-intensity (HR=0.79) CKRT were associated with significantly reduced 90-day mortality compared to high-intensity CKRT.
• A nonlinear dose-response relationship was observed, with lowest mortality rates at doses between 15-19.9 mL/kg/h.
• Sensitivity analyses confirmed these findings, indicating potential benefits from doses below the current KDIGO recommendation.

Conclusions:

• Both low and moderate CKRT intensities demonstrate reduced mortality in critically ill patients.
• The greatest survival benefit may occur at doses slightly lower than the current KDIGO-recommended range.
• Further investigation in randomized clinical trials is warranted to confirm these findings and refine CKRT dosing guidelines.