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Renal replacement therapy is an independent risk factor for mortality in critically ill patients with acute kidney injury

Monique M Elseviers1, Robert L Lins2*, Patricia Van der Niepen3, Eric Hoste4, Manu L Malbrain5, Pierre Damas6, Jacques Devriendt7 and the SHARF investigators

Author Affiliations

1 Department of Medicine, University of Antwerpen, Universiteitsplein 1, 2610 Wilrijk, Belgium

2 Nephrology-Hypertension, University of Antwerpen, Universiteitsplein 1, 2610 Wilrijk, Belgium

3 Nephrology-Hypertension, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium

4 Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium

5 Intensive Care Medicine, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060 Antwerpen, Belgium

6 Intensive Care Medicine, University Hospital Liège, Domaine Universitaire du Sart-Tilman, Bâtiment B35, 4000 Liège, Belgium

7 Brugmann University Hospital, Place Arthur Van Gehuchten 4, 1020 Brussels, Belgium

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Critical Care 2010, 14:R221 doi:10.1186/cc9355


See related commentary by Vinsonneau and Monchi, http://ccforum.com/content/15/1/112 and related letter by Pestaña, http://ccforum.com/content/15/2/415

Published: 1 December 2010

Abstract

Introduction

Outcome studies in patients with acute kidney injury (AKI) have focused on differences between modalities of renal replacement therapy (RRT). The outcome of conservative treatment, however, has never been compared with RRT.

Methods

Nine Belgian intensive care units (ICUs) included all adult patients consecutively admitted with serum creatinine >2 mg/dl. Included treatment options were conservative treatment and intermittent or continuous RRT. Disease severity was determined using the Stuivenberg Hospital Acute Renal Failure (SHARF) score. Outcome parameters studied were mortality, hospital length of stay and renal recovery at hospital discharge.

Results

Out of 1,303 included patients, 650 required RRT (58% intermittent, 42% continuous RRT). Overall results showed a higher mortality (43% versus 58%) as well as a longer ICU and hospital stay in RRT patients compared to conservative treatment. Using the SHARF score for adjustment of disease severity, an increased risk of death for RRT compared to conservative treatment of RR = 1.75 (95% CI: 1.4 to 2.3) was found. Additional correction for other severity parameters (Acute Physiology And Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA)), age, type of AKI and clinical conditions confirmed the higher mortality in the RRT group.

Conclusions

The SHARF study showed that the higher mortality expected in AKI patients receiving RRT versus conservative treatment can not only be explained by a higher disease severity in the RRT group, even after multiple corrections. A more critical approach to the need for RRT in AKI patients seems to be warranted.