Association between renal replacement therapy in critically ill patients with severe acute kidney injury and mortality

作者：Bagshaw Sean M^*; Uchino Shigehiko; Kellum John A; Morimatsu Hiroshi; Morgera Stanislao; Schetz Miet; Tan Ian; Bouman Catherine; Macedo Etienne; Gibney Noel; Tolwani Ashita; Oudemans van Straaten Heleen M; Ronco Claudio; Bellomo Rinaldo

来源：Journal of Critical Care, 2013, 28(6): 1011-1018.

DOI：10.1016/j.jcrc.2013.08.002

• Acute kidney injury
• Critical illness
• Renal replacement therapy
• RIFLE criteria
• Mortality
• Length of stay
• Renal recovery

Purpose: To evaluate the characteristics and outcomes of critically ill patients with severe acute kidney injury (AKI) treated and not treated with renal replacement therapy (RRT). %26lt;br%26gt;Methods: Secondary analysis of a multi-centre cohort study. Primary exposure was RRT. Primary outcome was propensity and multi-variable adjusted-hospital mortality. %26lt;br%26gt;Results: We studied 1250 patients (71.3%) who received and 502 (28.7%) who did not receive RRT. Reasons for not starting RRT (not mutually exclusive) were limitations of support (33.6%, n=169), adequate urine output (46.2%; n=232), plan to observe (56.4%; n=283), and advanced age (12.6%; n=63). Mortality was higher in those not receiving RRT due to limitations and advanced age but lower for adequate urine output and plan to observe. Propensity and multi-variable adjusted analysis showed no statistical difference in hospital mortality (adj-OR 1.47; 95% CI, 0.93-2.24) in patients receiving RRT. Results were similar in a sensitivity analysis restricted to patients fulfilling risk, injury, failure, loss, end-stage kidney disease-FAILURE criteria (37.0%; n=446) (adj-OR 1.36; 95% CI, 0.70-2.66). %26lt;br%26gt;Conclusion: In this cohort, reasons for not starting RRT included limitations of support and perception of impending renal recovery. Despite similar risk of mortality after adjusting for selection bias and confounders, RRT-treated patients were fundamentally different from non-treated patients across a spectrum of variables that precludes valid comparison in observational data.

• 出版日期2013-12