Choice of renal replacement therapy modality in intensive care units: data from a Japanese Nationwide Administrative Claim Database.

Abstract

PURPOSE:

This study was undertaken to assess recent trends of the choice of renal replacement therapy (RRT) modalities in Japanese intensive care units (ICUs).

MATERIALS AND METHODS:

Data were extracted from the Japanese Diagnosis Procedure Combination database for 2011. We identified adult patients without end-stage renal disease who had been admitted to ICUs for 3 days or longer and started continuous RRT (CRRT) or intermittent RRT (IRRT). Logistic regression was used to analyze which factors affected the modality choice. We further evaluated in-hospital mortality according to the choice of RRT.

RESULTS:

Of 7353 eligible patients, 5854 (79.6%) initially received CRRT. The choice of CRRT was independently associated with sex (female), diagnosis of sepsis, hospital type (academic) and volume, vasoactive agents, mechanical ventilation, colloid administration, blood transfusion, intra-aortic balloon pumping, and venoarterial extracorporeal membrane oxygenation. Particularly, the number of vasoactive drugs was strongly associated with the CRRT choice. Overall in-hospital mortality in the CRRT group was higher than that in the IRRT group (50.0% vs 31.1%) and was increased when IRRT was switched to CRRT (59.1%).

CONCLUSIONS:

Continuous RRT is apparently preferred in actual ICU practice, especially for hemodynamically unstable patients, and subsequent RRT modality switch is associated with mortality.

• Authors: Masao Iwagami, Hideo Yasunaga, Eisei Noiri, Hiromasa Horiguchi, Kiyohide Fushimi, Takehiro Matsubara, Naoki Yahagi, Masaomi Nangaku, Kent Doi
• Journal: Journal of critical care (J Crit Care) Vol. 30 Issue 2 Pg. 381-5 (Apr 2015) ISSN: 1557-8615 [Electronic] United States
• PMID: 25434720 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Topics

• Acute Kidney Injury
• Adult
• Aged
• Aged, 80 and over
• Databases, Factual
• Female
• Hospital Mortality
• Humans
• Intensive Care Units
• Kidney Failure, Chronic (mortality, therapy)
• Logistic Models
• Male
• Middle Aged
• Renal Replacement Therapy (methods)
• Respiration, Artificial