Validity of low-intensity continuous renal replacement therapy*.
Abstract
OBJECTIVE: To study the hospital mortality of patients with severe acute kidney injury
treated with low-intensity continuous renal replacement therapy. DESIGN: Multicenter
retrospective observational study (Japanese Society for Physicians and Trainees in
Intensive Care), combined with previously conducted multinational prospective observational
study (Beginning and Ending Supportive Therapy). SETTING: Fourteen Japanese ICUs in
12 tertiary hospitals (Japanese Society for Physicians and Trainees in Intensive Care)
and 54 ICUs in 23 countries (Beginning and Ending Supportive Therapy). PATIENTS: Consecutive
adult patients with severe acute kidney injury requiring continuous renal replacement
therapy admitted to the participating ICUs in 2010 (Japanese Society for Physicians
and Trainees in Intensive Care, n = 343) and 2001 (Beginning and Ending Supportive
Therapy Beginning and Ending Supportive Therapy, n = 1,006). INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Patient characteristics, variables at continuous renal
replacement therapy initiation, continuous renal replacement therapy settings, and
outcomes (ICU and hospital mortality and renal replacement therapy requirement at
hospital discharge) were collected. Continuous renal replacement therapy intensity
was arbitrarily classified into seven subclasses: less than 10, 10-15, 15-20, 20-25,
25-30, 30-35, and more than 35 mL/kg/hr. Multivariable logistic regression analysis
was conducted to investigate risk factors for hospital mortality. The continuous renal
replacement therapy dose in the Japanese Society for Physicians and Trainees in Intensive
Care database was less than half of the Beginning and Ending Supportive Therapy database
(800 mL/hr vs 2,000 mL/hr, p < 0.001). Even after adjusting for the body weight and
dilution factor, continuous renal replacement therapy intensity was statistically
different (14.3 mL/kg/hr vs 20.4 mL/kg/hr, p < 0.001). Patients in the Japanese Society
for Physicians and Trainees in Intensive Care database had a lower ICU mortality (46.1%
vs 55.3%, p = 0.003) and hospital mortality (58.6% vs 64.2%, p = 0.070) compared with
patients in the Beginning and Ending Supportive Therapy database. In multivariable
regression analysis after combining the two databases, no continuous renal replacement
therapy intensity subclasses were found to be statistically different from the reference
intensity (20-25 mL/kg/hr). Several sensitivity analyses (patients with sepsis, patients
from Western countries in the Beginning and Ending Supportive Therapy database) confirmed
no intensity-outcome relationship. CONCLUSIONS: Continuous renal replacement therapy
at a mean intensity of 14.3 mL/kg/hr did not have worse outcome compared with 20-25
mL/kg/hr of continuous renal replacement therapy, currently considered the standard
intensity. However, our study is insufficient to support the use of low-intensity
continuous renal replacement therapy, and more studies are needed to confirm our findings.
Type
Journal articleSubject
Japanese Society for Physicians and Trainees in Intensive Care (JSEPTIC) Clinical
Trial GroupHumans
Hemofiltration
APACHE
Hospital Mortality
Risk Factors
Retrospective Studies
Aged
Middle Aged
Japan
Female
Male
Acute Kidney Injury
Tertiary Care Centers
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https://hdl.handle.net/10161/21339Published Version (Please cite this version)
10.1097/ccm.0b013e318298622ePublication Info
Uchino, Shigehiko; Toki, Noriyoshi; Takeda, Kenta; Ohnuma, Tetsu; Namba, Yoshitomo;
Katayama, Shinshu; ... Japanese Society for Physicians and Trainees in Intensive Care
(JSEPTIC) Clinical Trial Group (2013). Validity of low-intensity continuous renal replacement therapy*. Critical care medicine, 41(11). pp. 2584-2591. 10.1097/ccm.0b013e318298622e. Retrieved from https://hdl.handle.net/10161/21339.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Tetsu Ohnuma
Assistant Professor in Anesthesiology

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