Epidemiology and Outcomes of AKI Treated With Continuous Kidney Replacement Therapy: The Multicenter CRRTnet Study

Oleksa G Rewa; Victor Ortiz-Soriano; Joshua Lambert; Shaowli Kabir; Michael Heung; Andrew A House; Divya Monga; Luis A Juncos; Michelle Secic; Robin Piazza; Stuart L Goldstein; Sean M Bagshaw; Javier A Neyra

doi:10.1016/j.xkme.2023.100641

Epidemiology and Outcomes of AKI Treated With Continuous Kidney Replacement Therapy: The Multicenter CRRTnet Study

Kidney Med. 2023 Apr 15;5(6):100641. doi: 10.1016/j.xkme.2023.100641. eCollection 2023 Jun.

Authors

Oleksa G Rewa¹, Victor Ortiz-Soriano², Joshua Lambert³, Shaowli Kabir⁴, Michael Heung⁵, Andrew A House⁶, Divya Monga⁷, Luis A Juncos^{8

9}, Michelle Secic¹⁰, Robin Piazza¹¹, Stuart L Goldstein¹², Sean M Bagshaw¹, Javier A Neyra^{2

13}

Affiliations

¹ Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton Alberta Canada.
² Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY.
³ College of Nursing, University of Cincinnati, Cincinnati, OH.
⁴ Department of Biostatistics, University of Kentucky, Lexington, KY.
⁵ Division of Nephrology, University of Michigan, Ann Arbor, MI.
⁶ Division of Nephrology, Western University and London Health Sciences Centre, London, Canada.
⁷ Division of Nephrology, University of Mississippi, Jackson, MI.
⁸ Central Arkansas Veterans Healthcare System (CAVHS), Little Rock, Arkansas.
⁹ University of Arkansas for Medical Sciences, Little Rock, Arkansas.
¹⁰ Secic Statistical Consulting, Chardon, OH.
¹¹ Watermark Research Partners, Inc, Indianapolis, IN.
¹² Center for Acute Care Nephrology, Cincinnati Children's Hospital and Medical Center, University of Cincinnati, Cincinnati, OH.
¹³ Department of Internal Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL.

Abstract

Rationale & objective: Continuous kidney replacement therapy (CKRT) is the predominant form of acute kidney replacement therapy used for critically ill adult patients with acute kidney injury (AKI). Given the variability in CKRT practice, a contemporary understanding of its epidemiology is necessary to improve care delivery.

Study design: Multicenter, prospective living registry.

Setting & population: 1,106 critically ill adults with AKI requiring CKRT from December 2013 to January 2021 across 5 academic centers and 6 intensive care units. Patients with pre-existing kidney failure and those with coronavirus 2 infection were excluded.

Exposure: CKRT for more than 24 hours.

Outcomes: Hospital mortality, kidney recovery, and health care resource utilization.

Analytical approach: Data were collected according to preselected timepoints at intensive care unit admission and CKRT initiation and analyzed descriptively.

Results: Patients' characteristics, contributors to AKI, and CKRT indications differed among centers. Mean (standard deviation) age was 59.3 (13.9) years, 39.7% of patients were women, and median [IQR] APACHE-II (acute physiologic assessment and chronic health evaluation) score was 30 [25-34]. Overall, 41.1% of patients survived to hospital discharge. Patients that died were older (mean age 61 vs. 56.8, P < 0.001), had greater comorbidity (median Charlson score 3 [1-4] vs. 2 [1-3], P < 0.001), and higher acuity of illness (median APACHE-II score 30 [25-35] vs. 29 [24-33], P = 0.003). The most common condition predisposing to AKI was sepsis (42.6%), and the most common CKRT indications were oliguria/anuria (56.2%) and fluid overload (53.9%). Standardized mortality ratios were similar among centers.

Limitations: The generalizability of these results to CKRT practices in nonacademic centers or low-and middle-income countries is limited.

Conclusions: In this registry, sepsis was the major contributor to AKI and fluid management was collectively the most common CKRT indication. Significant heterogeneity in patient- and CKRT-specific characteristics was found in current practice. These data highlight the need for establishing benchmarks of CKRT delivery, performance, and patient outcomes. Data from this registry could assist with the design of such studies.

Keywords: AKI; Acute kidney injury; CKRT; CRRT; continuous kidney replacement therapy; continuous renal replacement therapy; epidemiology; intensive care unit.