Author(s):
Vesconi, S. 
; Cruz, D. ; Fumagalli, R. ; Kindgen-Milles, D. ; Monti, G. ; Marinho, A. ; Mariano, F. ; Formica, M. ; Marchesi, M. ; René, R. ; Livigni, S. ; Ronco, C.
Date: 2009
Persistent ID: http://hdl.handle.net/10400.16/350
Origin: Repositório Científico do Centro Hospitalar do Porto
Description
Introduction The optimal dialysis dose for the treatment of
acute kidney injury (AKI) is controversial. We sought to evaluate
the relationship between renal replacement therapy (RRT) dose
and outcome.
Methods We performed a prospective multicentre
observational study in 30 intensive care units (ICUs) in eight
countries from June 2005 to December 2007. Delivered RRT
dose was calculated in patients treated exclusively with either
continuous RRT (CRRT) or intermittent RRT (IRRT) during their
ICU stay. Dose was categorised into more-intensive (CRRT ≥
35 ml/kg/hour, IRRT ≥ 6 sessions/week) or less-intensive
(CRRT < 35 ml/kg/hour, IRRT < 6 sessions/week). The main
outcome measures were ICU mortality, ICU length of stay and
duration of mechanical ventilation.
Results Of 15,200 critically ill patients admitted during the
study period, 553 AKI patients were treated with RRT, including
338 who received CRRT only and 87 who received IRRT only.
For CRRT, the median delivered dose was 27.1 ml/kg/hour
(interquartile range (IQR) = 22.1 to 33.9). For IRRT, the median
dose was 7 sessions/week (IQR = 5 to 7). Only 22% of CRRT
patients and 64% of IRRT patients received a more-intensive
dose. Crude ICU mortality among CRRT patients were 60.8% vs. 52.5% (more-intensive vs. less-intensive groups,
respectively). In IRRT, this was 23.6 vs. 19.4%, respectively. On
multivariable analysis, there was no significant association
between RRT dose and ICU mortality (Odds ratio (OR) moreintensive
vs. less-intensive: CRRT OR = 1.21, 95% confidence
interval (CI) = 0.66 to 2.21; IRRT OR = 1.50, 95% CI = 0.48 to
4.67). Among survivors, shorter ICU stay and duration of
mechanical ventilation were observed in the more-intensive RRT
groups (more-intensive vs. less-intensive for all: CRRT (median):
15 (IQR = 8 to 26) vs. 19.5 (IQR = 12 to 33.5) ICU days, P =
0.063; 7 (IQR = 4 to 17) vs. 14 (IQR = 5 to 24) ventilation days,
P = 0.031; IRRT: 8 (IQR = 5.5 to 14) vs. 18 (IQR = 13 to 35)
ICU days, P = 0.008; 2.5 (IQR = 0 to 10) vs. 12 (IQR = 3 to 24)
ventilation days, P = 0.026).
Conclusions After adjustment for multiple variables, these data
provide no evidence for a survival benefit afforded by higher
dose RRT. However, more-intensive RRT was associated with a
favourable effect on ICU stay and duration of mechanical
ventilation among survivors. This result warrants further
exploration.
Trial Registration Cochrane Renal Group (CRG110600093).
