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Title: Higher versus Lower Continuous Renal Replacement Therapy Intensity in Critically ill Patients with Liver Dysfunction.
Austin Authors: O'Brien, Zachary ;Cass, Alan;Cole, Louise;Finfer, Simon;Gallagher, Martin;McArthur, Colin;McGuiness, Shay;Myburgh, John;Bellomo, Rinaldo ;Martensson, Johan
Affiliation: Cardiovascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
Department of Intensive Care, Nepean Hospital, Sydney, NSW, Australia
Issue Date: 2018 2017-11-22
Publication information: Blood Purification 2018; 45(1-3): 36-43
Abstract: 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.
DOI: 10.1159/000480224
ORCID: 0000-0001-8739-7896
PubMed URL: 29161684
Type: Journal Article
Subjects: Acute kidney injury
Continuous renal replacement therapy
Liver dysfunction
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