Comparison of Outcomes of Different Modalities of Renal Replacement Therapy in Patients of Acute Kidney Injury: A Single Centre Prospective Observational Study

H K Aggarwal; Deepak Jain; Arpit Agarwal; Shaveta Dahiya; Prabhakar Misra; Arup Saha

doi:10.2478/rjim-2023-0033

Comparison of Outcomes of Different Modalities of Renal Replacement Therapy in Patients of Acute Kidney Injury: A Single Centre Prospective Observational Study

Rom J Intern Med. 2023 Dec 28. doi: 10.2478/rjim-2023-0033. Online ahead of print.

Authors

H K Aggarwal¹, Deepak Jain², Arpit Agarwal³, Shaveta Dahiya⁴, Prabhakar Misra⁵, Arup Saha⁶

Affiliations

¹ 1Sr. Professor & Head, Department of Medicine, PGIMS, Rohtak, India.
² 2Sr. Professor, Department of Medicine, PGIMS, Rohtak, India.
³ 3Resident, Department of Medicine, Department of Medicine, PGIMS, Rohtak, India.
⁴ 4Assistant professor, Department of Medicine, PGIMS, Rohtak, India.
⁵ 5Additional Professor, Dept. of Biostatistics, SGPGIMS Lucknow.
⁶ 6Senior Resident, Department of Community Medicine, Andaman & Nicobar Islands Institute of Medical Sciences, A & N Island.

PMID: 38153884
DOI: 10.2478/rjim-2023-0033

Abstract

Background: Acute Kidney Injury (AKI) is one of the most important causes of in-hospital mortality. The global burden of AKI continues to rise without a marked reduction in mortality. As such, the use of renal replacement therapy (RRT) forms an integral part of AKI management, especially in critically ill patients. There has been much debate over the preferred modality of RRT between continuous, intermittent and intermediate modes. While there is abundant data from Europe and North America, data from tropical countries especially the Indian subcontinent is sparse. Our study aims to provide an Indian perspective on the dialytic management of tropical AKI in a tertiary care hospital setup.

Methods: 90 patients of AKI, 30 each undergoing Continuous Renal Replacement Therapy (CRRT), Intermittent Hemodialysis (IHD) and SLED (Sustained Low-Efficiency Dialysis) were included in this prospective cohort study. At the end of 28 days of hospital stay, discharge or death, outcome measures were ascertained which included mortality, duration of hospital stay, recovery of renal function and requirement of RRT after discharge. In addition median of the net change of renal parameters was also computed across the three groups. Lastly, Kaplan Meier analysis was performed to assess the probability of survival with the use of each modality of RRT.

Results: There was no significant difference in the primary outcome of mortality between the three cohorts (p=0.27). However, CRRT was associated with greater renal recovery (p= 0.015) than IHD or SLED. On the other hand, SLED and IHD were associated with a greater net reduction in blood urea (p=0.004) and serum creatinine (p=0.053).

Conclusion: CRRT, IHD and SLED are all complementary to each other and are viable options in the treatment of AKI patients.

Keywords: Acute Kidney Injury (AKI); BU (Blood Urea); CRRT (Continuous Renal Replacement Therapy); IHD (Intermittent Hemodialysis); MAP (Mean Arterial Pressure); Renal Replacement Therapy (RRT); SCr (Serum Creatinine); SLED (Sustained Low-Efficiency Dialysis); SOFA score (Sequential Organ Failure Assessment score); UO (Urine Output).