Modality of RRT and Recovery of Kidney Function after AKI in Patients Surviving to Hospital Discharge
Observational evidence has suggested that RRT modality may affect recovery after AKI. It is unclear whether initial choice of intermittent hemodialysis or continuous RRT affects renal recovery, survival, or development of ESRD in critically ill patients when modality choice is made primarily on hemo...
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| Veröffentlicht in: | Clinical journal of the American Society of Nephrology 2016-01, Vol.11 (1), p.30-38 |
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| creator | Liang, Kelly V Sileanu, Florentina E Clermont, Gilles Murugan, Raghavan Pike, Francis Palevsky, Paul M Kellum, John A |
| description | Observational evidence has suggested that RRT modality may affect recovery after AKI. It is unclear whether initial choice of intermittent hemodialysis or continuous RRT affects renal recovery, survival, or development of ESRD in critically ill patients when modality choice is made primarily on hemodynamics.
We performed a retrospective cohort study examining adults (≥18 years old) admitted to intensive care units from 2000 to 2008 who received RRT for AKI and survived to hospital discharge or 90 days. We analyzed renal recovery (alive and not requiring RRT) and reasons for nonrecovery (death or ESRD) at 90 and 365 days. Conditional multivariable logistic regression was used to assess differences in renal recovery at 90 and 365 days between continuous RRT and intermittent hemodialysis. Models were stratified by propensity for continuous RRT and adjusted for age and reference creatinine.
Of 4738 patients with Kidney Disease Improving Global Outcomes stage 3 AKI, 1338 (28.2%) received RRT, and 638 (47.7%) survived to hospital discharge (353 intermittent hemodialysis and 285 continuous RRT). Recovery from AKI was lower for intermittent hemodialysis versus continuous RRT at 90 days (66.6% intermittent hemodialysis versus 75.4% continuous RRT; P=0.02) but similar at 365 days (54.1% intermittent hemodialysis versus 59.6% continuous RRT; P=0.17). In multivariable analysis, there was no difference in odds of recovery at 90 or 365 days for patients initially treated with continuous RRT versus intermittent hemodialysis (90 days: odds ratio, 1.19; 95% confidence interval, 0.91 to 1.55; P=0.20; 365 days: odds ratio, 0.93; 95% confidence interval, 0.72 to 1.2; P=0.55).
We found no significant difference in hazards for nonrecovery or reasons for nonrecovery (mortality or ESRD) with intermittent hemodialysis versus continuous RRT. These results suggest that, when initial RRT modality is chosen primarily on hemodynamics, renal recovery and clinical outcomes in survivors are similar between intermittent hemodialysis and continuous RRT. |
| doi_str_mv | 10.2215/CJN.01290215 |
| format | Article |
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We performed a retrospective cohort study examining adults (≥18 years old) admitted to intensive care units from 2000 to 2008 who received RRT for AKI and survived to hospital discharge or 90 days. We analyzed renal recovery (alive and not requiring RRT) and reasons for nonrecovery (death or ESRD) at 90 and 365 days. Conditional multivariable logistic regression was used to assess differences in renal recovery at 90 and 365 days between continuous RRT and intermittent hemodialysis. Models were stratified by propensity for continuous RRT and adjusted for age and reference creatinine.
Of 4738 patients with Kidney Disease Improving Global Outcomes stage 3 AKI, 1338 (28.2%) received RRT, and 638 (47.7%) survived to hospital discharge (353 intermittent hemodialysis and 285 continuous RRT). Recovery from AKI was lower for intermittent hemodialysis versus continuous RRT at 90 days (66.6% intermittent hemodialysis versus 75.4% continuous RRT; P=0.02) but similar at 365 days (54.1% intermittent hemodialysis versus 59.6% continuous RRT; P=0.17). In multivariable analysis, there was no difference in odds of recovery at 90 or 365 days for patients initially treated with continuous RRT versus intermittent hemodialysis (90 days: odds ratio, 1.19; 95% confidence interval, 0.91 to 1.55; P=0.20; 365 days: odds ratio, 0.93; 95% confidence interval, 0.72 to 1.2; P=0.55).
We found no significant difference in hazards for nonrecovery or reasons for nonrecovery (mortality or ESRD) with intermittent hemodialysis versus continuous RRT. These results suggest that, when initial RRT modality is chosen primarily on hemodynamics, renal recovery and clinical outcomes in survivors are similar between intermittent hemodialysis and continuous RRT.</description><identifier>ISSN: 1555-9041</identifier><identifier>EISSN: 1555-905X</identifier><identifier>DOI: 10.2215/CJN.01290215</identifier><identifier>PMID: 26681135</identifier><language>eng</language><publisher>United States: American Society of Nephrology</publisher><subject>Acute Kidney Injury - physiopathology ; Acute Kidney Injury - therapy ; Adolescent ; Adult ; Aged ; Female ; Humans ; Kidney - physiopathology ; Logistic Models ; Male ; Middle Aged ; Original ; Patient Discharge ; Renal Dialysis ; Renal Replacement Therapy ; Retrospective Studies</subject><ispartof>Clinical journal of the American Society of Nephrology, 2016-01, Vol.11 (1), p.30-38</ispartof><rights>Copyright © 2016 by the American Society of Nephrology.</rights><rights>Copyright © 2016 by the American Society of Nephrology 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-be3666b54cf4b828102692df40df304ff6ed015d1dc605991f8ad1692f2b4ddc3</citedby><cites>FETCH-LOGICAL-c384t-be3666b54cf4b828102692df40df304ff6ed015d1dc605991f8ad1692f2b4ddc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4702218/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4702218/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26681135$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Liang, Kelly V</creatorcontrib><creatorcontrib>Sileanu, Florentina E</creatorcontrib><creatorcontrib>Clermont, Gilles</creatorcontrib><creatorcontrib>Murugan, Raghavan</creatorcontrib><creatorcontrib>Pike, Francis</creatorcontrib><creatorcontrib>Palevsky, Paul M</creatorcontrib><creatorcontrib>Kellum, John A</creatorcontrib><title>Modality of RRT and Recovery of Kidney Function after AKI in Patients Surviving to Hospital Discharge</title><title>Clinical journal of the American Society of Nephrology</title><addtitle>Clin J Am Soc Nephrol</addtitle><description>Observational evidence has suggested that RRT modality may affect recovery after AKI. It is unclear whether initial choice of intermittent hemodialysis or continuous RRT affects renal recovery, survival, or development of ESRD in critically ill patients when modality choice is made primarily on hemodynamics.
We performed a retrospective cohort study examining adults (≥18 years old) admitted to intensive care units from 2000 to 2008 who received RRT for AKI and survived to hospital discharge or 90 days. We analyzed renal recovery (alive and not requiring RRT) and reasons for nonrecovery (death or ESRD) at 90 and 365 days. Conditional multivariable logistic regression was used to assess differences in renal recovery at 90 and 365 days between continuous RRT and intermittent hemodialysis. Models were stratified by propensity for continuous RRT and adjusted for age and reference creatinine.
Of 4738 patients with Kidney Disease Improving Global Outcomes stage 3 AKI, 1338 (28.2%) received RRT, and 638 (47.7%) survived to hospital discharge (353 intermittent hemodialysis and 285 continuous RRT). Recovery from AKI was lower for intermittent hemodialysis versus continuous RRT at 90 days (66.6% intermittent hemodialysis versus 75.4% continuous RRT; P=0.02) but similar at 365 days (54.1% intermittent hemodialysis versus 59.6% continuous RRT; P=0.17). In multivariable analysis, there was no difference in odds of recovery at 90 or 365 days for patients initially treated with continuous RRT versus intermittent hemodialysis (90 days: odds ratio, 1.19; 95% confidence interval, 0.91 to 1.55; P=0.20; 365 days: odds ratio, 0.93; 95% confidence interval, 0.72 to 1.2; P=0.55).
We found no significant difference in hazards for nonrecovery or reasons for nonrecovery (mortality or ESRD) with intermittent hemodialysis versus continuous RRT. These results suggest that, when initial RRT modality is chosen primarily on hemodynamics, renal recovery and clinical outcomes in survivors are similar between intermittent hemodialysis and continuous RRT.</description><subject>Acute Kidney Injury - physiopathology</subject><subject>Acute Kidney Injury - therapy</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Female</subject><subject>Humans</subject><subject>Kidney - physiopathology</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Patient Discharge</subject><subject>Renal Dialysis</subject><subject>Renal Replacement Therapy</subject><subject>Retrospective Studies</subject><issn>1555-9041</issn><issn>1555-905X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkclPAyEUxonRuN88G44erAIDOHMxMdVarVuqJt4Iw1IxU6jANOl_77g1euLx3i_fWz4A9jA6IgSz4_713RHCpELdZwVsYsZYr0LsZXUZU7wBtlJ6Q4jSgrB1sEE4LzEu2CYwt0HLxuUFDBaOx09Qeg3HRoW5iV-5kdPeLOCg9Sq74KG02UR4NrqCzsMHmZ3xOcHHNs7d3PkJzAEOQ5q5LBt47pJ6lXFidsCalU0yuz_vNngeXDz1h72b-8ur_tlNTxUlzb3aFJzzmlFlaV2SEiPCK6ItRdoWiFrLjUaYaawVR6yqsC2lxh1iSU21VsU2OP3WnbX11GjVzRZlI2bRTWVciCCd-F_x7lVMwlzQE9Qds-wEDn4EYnhvTcpi2u1gmkZ6E9ok8AlHFSoZ_0QPv1EVQ0rR2GUbjMSnM6JzRvw60-H7f0dbwr9WFB_-1YoI</recordid><startdate>20160107</startdate><enddate>20160107</enddate><creator>Liang, Kelly V</creator><creator>Sileanu, Florentina E</creator><creator>Clermont, Gilles</creator><creator>Murugan, Raghavan</creator><creator>Pike, Francis</creator><creator>Palevsky, Paul M</creator><creator>Kellum, John A</creator><general>American Society of Nephrology</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160107</creationdate><title>Modality of RRT and Recovery of Kidney Function after AKI in Patients Surviving to Hospital Discharge</title><author>Liang, Kelly V ; Sileanu, Florentina E ; Clermont, Gilles ; Murugan, Raghavan ; Pike, Francis ; Palevsky, Paul M ; Kellum, John A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c384t-be3666b54cf4b828102692df40df304ff6ed015d1dc605991f8ad1692f2b4ddc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Acute Kidney Injury - physiopathology</topic><topic>Acute Kidney Injury - therapy</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Female</topic><topic>Humans</topic><topic>Kidney - physiopathology</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Patient Discharge</topic><topic>Renal Dialysis</topic><topic>Renal Replacement Therapy</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Liang, Kelly V</creatorcontrib><creatorcontrib>Sileanu, Florentina E</creatorcontrib><creatorcontrib>Clermont, Gilles</creatorcontrib><creatorcontrib>Murugan, Raghavan</creatorcontrib><creatorcontrib>Pike, Francis</creatorcontrib><creatorcontrib>Palevsky, Paul M</creatorcontrib><creatorcontrib>Kellum, John A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical journal of the American Society of Nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liang, Kelly V</au><au>Sileanu, Florentina E</au><au>Clermont, Gilles</au><au>Murugan, Raghavan</au><au>Pike, Francis</au><au>Palevsky, Paul M</au><au>Kellum, John A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Modality of RRT and Recovery of Kidney Function after AKI in Patients Surviving to Hospital Discharge</atitle><jtitle>Clinical journal of the American Society of Nephrology</jtitle><addtitle>Clin J Am Soc Nephrol</addtitle><date>2016-01-07</date><risdate>2016</risdate><volume>11</volume><issue>1</issue><spage>30</spage><epage>38</epage><pages>30-38</pages><issn>1555-9041</issn><eissn>1555-905X</eissn><abstract>Observational evidence has suggested that RRT modality may affect recovery after AKI. It is unclear whether initial choice of intermittent hemodialysis or continuous RRT affects renal recovery, survival, or development of ESRD in critically ill patients when modality choice is made primarily on hemodynamics.
We performed a retrospective cohort study examining adults (≥18 years old) admitted to intensive care units from 2000 to 2008 who received RRT for AKI and survived to hospital discharge or 90 days. We analyzed renal recovery (alive and not requiring RRT) and reasons for nonrecovery (death or ESRD) at 90 and 365 days. Conditional multivariable logistic regression was used to assess differences in renal recovery at 90 and 365 days between continuous RRT and intermittent hemodialysis. Models were stratified by propensity for continuous RRT and adjusted for age and reference creatinine.
Of 4738 patients with Kidney Disease Improving Global Outcomes stage 3 AKI, 1338 (28.2%) received RRT, and 638 (47.7%) survived to hospital discharge (353 intermittent hemodialysis and 285 continuous RRT). Recovery from AKI was lower for intermittent hemodialysis versus continuous RRT at 90 days (66.6% intermittent hemodialysis versus 75.4% continuous RRT; P=0.02) but similar at 365 days (54.1% intermittent hemodialysis versus 59.6% continuous RRT; P=0.17). In multivariable analysis, there was no difference in odds of recovery at 90 or 365 days for patients initially treated with continuous RRT versus intermittent hemodialysis (90 days: odds ratio, 1.19; 95% confidence interval, 0.91 to 1.55; P=0.20; 365 days: odds ratio, 0.93; 95% confidence interval, 0.72 to 1.2; P=0.55).
We found no significant difference in hazards for nonrecovery or reasons for nonrecovery (mortality or ESRD) with intermittent hemodialysis versus continuous RRT. These results suggest that, when initial RRT modality is chosen primarily on hemodynamics, renal recovery and clinical outcomes in survivors are similar between intermittent hemodialysis and continuous RRT.</abstract><cop>United States</cop><pub>American Society of Nephrology</pub><pmid>26681135</pmid><doi>10.2215/CJN.01290215</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acute Kidney Injury - physiopathology Acute Kidney Injury - therapy Adolescent Adult Aged Female Humans Kidney - physiopathology Logistic Models Male Middle Aged Original Patient Discharge Renal Dialysis Renal Replacement Therapy Retrospective Studies |
| title | Modality of RRT and Recovery of Kidney Function after AKI in Patients Surviving to Hospital Discharge |
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