The following is a summary of” Epidemiology and Outcomes of AKI Treated With Continuous Kidney Replacement Therapy: The Multicenter CRRTnet Study,” published in the June 2023 issue of the Kidney Medicine by Rewa et al.
Continuous kidney replacement therapy (CKRT) is the most common type of acute kidney replacement therapy administered to critically ill adult patients with acute kidney injury (AKI). Given the variation in CKRT practice, an up-to-date comprehension of its epidemiology is essential for enhancing care delivery. A Multicenter, the prospective living registry was the study design. From December 2013 to January 2021, 1,106 critically ill adults with AKI required CKRT across five academic institutions and six intensive care units. Excluded were patients with preexisting kidney failure and coronavirus 2 infections. The duration of CKRT exposure exceeded 24 hours. The outcomes were hospital mortality, kidney recovery, and utilization of health care resources.
Data were collected and analyzed descriptively according to predetermined time points at intensive care unit admission and CKRT initiation. The characteristics of patients, the causes of AKI, and the indications for CKRT varied between centers. About 39.7% of patients were female, and the median [interquartile range] APACHE-II (acute physiologic assessment and chronic health evaluation) score was 30 [25-34]. Overall, 41.1% of patients survived to be discharged from the hospital. Patients who passed away were older (mean age 61 vs. 56.8, P <0.001), had more comorbidities (median Charlson score 3 [1-4] vs. 2 [1-3], P <0.001), and had a more severe illness (median APACHE-II score 30 [25-35] vs. 29 [24-35], P = 0.003). The most prevalent risk factor for AKI was sepsis (42.6%), and the most pervasive CKRT indications were oliguria/anuria (56.2%) and fluid excess (53.9%).
Mortality ratios were comparable between institutions. These findings have limited applicability to CKRT practices in non-academic institutions and low- and middle-income nations. In this registry, sepsis was the leading cause of AKI, and fluid management was the most prevalent CKRT indication. Current practice reveals significant heterogeneity in patient- and CKRT-specific characteristics. These findings emphasize the need to establish CKRT delivery, performance, and patient outcomes benchmarks. This registry’s information could aid in the design of such investigations.
Source: sciencedirect.com/science/article/pii/S2590059523000511