Higher versus Lower Continuous Renal Replacement Therapy Intensity in Critically ill Patients with Liver Dysfunction.

2018

O'Brien, Zachary

Cass, Alan

Cole, Louise

Finfer, Simon

Gallagher, Martin

McArthur, Colin

McGuiness, Shay

Myburgh, John

Bellomo, Rinaldo

Martensson, Johan

Acute kidney injury

Continuous renal replacement therapy

Liver dysfunction

Mortality

Journal Article

0000-0001-8739-7896

0000-0002-1650-8939

10.1159/000480224

To study the association between higher versus lower continuous renal replacement therapy (CRRT) intensity and mortality in critically ill patients with combined acute kidney injury and liver dysfunction. Post-hoc analysis of patients with liver dysfunction (Sequential Organ Failure Assessment liver score ≥2 or diagnosis of liver failure/transplant) included in the Randomized Evaluation of Normal versus Augmented Level renal replacement therapy (RENAL) trial. Of 444 patients, 210 (47.3%) were randomized to higher intensity (effluent flow 40 mL/kg/h) and 234 (52.7%) to lower intensity (effluent flow 25 mL/kg/h) therapy. Overall, 79 and 86% of prescribed effluent flow was delivered in the higher-intensity and lower-intensity groups, respectively (p < 0.001). In total, 113 (54.1%) and 120 (51.3%) patients died in each group. On multivariable Cox regression analysis, we found no independent association between higher CRRT intensity and mortality (HR 0.93, 95% CI 0.70-1.24; p = 0.642). In RENAL patients with liver dysfunction, higher CRRT intensity was not associated with reduced mortality.

link

Blood Purification 2018; 45(1-3): 36-43

Blood Purification