Continuous Renal Replacement Therapy Vs Intermittent Hemodialysis And Recovery Of Renal Function In Critically Ill Patients With Acute Kidney Injury

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Acute kidney injury (AKI) affects up to 40% of critically ill patients and is associated with high mortality. When renal replacement therapy (RRT) is required in critically ill patients, 10% become dependent on hemodialysis chronically which reduces quality of life and increases healthcare costs. Exploring novel approaches to expedite recovery of renal function has been an important research focus in recent years. The purpose of this study was to compare the effect of continuous renal replacement therapy (CRRT) versus intermittent hemodialysis (IHD) on the recovery of renal function in critically ill patients with AKI. METHODS: A retrospective observational study of critically ill adult patients with AKI who received RRT with CRRT vs IHD between 2013 and 2015 at the Hospital Universitario Mayor in Bogota was conducted. Recovery of renal function was defined as not requiring RRT at the time of discharge. RESULTS: Data were analyzed from 161 critically ill subjects with AKI that received IHD (n=80) vs. CRRT (n=81). Subjects had a mean age of 71 years and were more often male (64%). The most commonly associated pathology was sepsis in both IHD (58%) and CRRT (78%) arms and vasopressor use was similar in both groups (86% vs. 75%; p=0.07). The two most common indications for initiation of RRT were volume overload and uremia. There was a 1.9-fold increased relative risk [RR] of recovery of renal function in the CRRT group vs. IHD group (95%CI 1.08-3.35; p=0.021). Logistic regression analysis revealed that increases in age, positive fluid balance, and higher ultrafiltration requirements were associated with lower likelihood of renal function recovery, whereas longer length of hospital stay was surprisingly associated with greater likelihood of recovery. AKI associated with cardiovascular disease had a lower likelihood of recovery (OR=0.23), while AKI that developed during the post-cardiovascular surgery period had a higher likelihood of recovery (OR=6.2). A formula generated by a multivariate model using these factors was able to predict recovery of renal function (AUC ROC=0.86). Mortality rates during hospitalization were similar in both the CRRT and IHD arms (62% vs. 60%; p=0.82). CONCLUSIONS: CRRT was associated with higher rates of recovery of renal function in critically ill patients with AKI compared to IHD. Recovery of renal function was more likely with longer length of hospital stay and cardiovascular surgery with AKI, while advanced age, markers of significant hypervolemia (positive fluid balance, total ultrafiltration requirements), and history of cardiovascular disease were associated with lower likelihood of recovery of renal function. CLINICAL IMPLICATIONS: In critically ill patients with AKI requiring renal replacement therapy, CRRT was associated with higher rates of recovery of renal function compared to IHD. DISCLOSURES: Employee relationship with AstraZeneca Please note: $5001 - $20000 Added 06/01/2020 by Roberto Buitrago, source=Web Response, value=Salary Employee relationship with Baxter health care Please note: $5001 - $20000 Added 06/01/2020 by Jorge Echeverri, source=Web Response, value=Salary No relevant relationships by Manuel Huerfano, source=Admin input No relevant relationships by Gabriel Ortiz Jaimes, source=Web Response Employee relationship with RTS Baxter Colombi Please note: $5001 - $20000 Added 06/01/2020 by Maurcio Sanabria, source=Web Response, value=Salary No relevant relationships by Nilam Soni, source=Web Response Employee relationship with RTS Baxter Please note: $5001 - $20000 Added 06/01/2020 by Maria Jose Vargas, source=Web Response, value=Salary