Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/34042
Title: Impact of Intensity of Continuous Renal Replacement Therapy on Duration of Ventilation in Critically Ill Patients: A Secondary Analysis of the RENAL Trial.
Austin Authors: Serpa Neto, Ary ;Naorungroj, Thummaporn ;Gallagher, Martin;Bellomo, Rinaldo 
Affiliation: Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.;Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.
Intensive Care
Department of Nephrology, The George Institute for Global Health and University of Sydney, Sydney, New South Wales, Australia.
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.;Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.;Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, Melbourne, Victoria, Australia.;Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.;Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Data Analytics Research and Evaluation (DARE) Centre
Department of Intensive Care, Faculty of Medicine, Mahidol University, Bangkok, Thailand.
Department of Critical Care Medicine Hospital Israelita Albert Einstein, São Paulo, Brazil.
Issue Date: 18-Oct-2023
Date: 2023
Publication information: Blood Purification 2023; 52(11-12)
Abstract: More intensive renal replacement therapy (RRT) has been associated with prolonged mechanical ventilation (MV). However, such finding may be dependent on RRT modality. We hypothesized that, when using continuous renal replacement therapy (CRRT), RRT intensity would not be associated with prolonged MV. In a secondary analysis of the Randomized Evaluation of Normal versus Augmented Level (RENAL) Replacement trial comparing different CRRT intensities, we applied Fine-Gray competing risk analysis with time to successful extubation within 28 days as primary outcome. We studied 531 patients in the higher intensity and 551 in the lower intensity group. Higher intensity patients had more hypophosphatemia (66.7 vs. 58.1%; p = 0.004) and more days with hypophosphatemia (2.2 ± 2.8 vs. 1.6 ± 2.2; p < 0.001). There was no difference in the number of patients extubated within 28 days (60.1% vs. 62.4%; adjusted subdistribution hazard ratio [SHR], 0.95 [95% CI, 0.86 to 1.06]) or time to extubation (8 [5-16] vs. 8 [5-15] days; adjusted median difference, 0.65 [95% CI, -0.41 to 1.70]). Among patients from the upper tertile of days with hypophosphatemia, higher intensity CRRT was associated with a lower chance of successful extubation within 28 days (SHR, 0.67 [95% CI, 0.55 to 0.82]; p for heterogeneity = 0.013). In the RENAL trial, higher intensity CRRT was not associated with delayed extubation. However, it was associated with a greater rate of hypophosphatemia and more days with hypophosphatemia was associated with a lower chance of successful extubation.
URI: https://ahro.austin.org.au/austinjspui/handle/1/34042
DOI: 10.1159/000533687
ORCID: 
Journal: Blood Purification
Start page: 1
End page: 10
PubMed URL: 37852200
ISSN: 1421-9735
Type: Journal Article
Subjects: Acute kidney injury
Continuous renal replacement therapy
Mechanical ventilation
Renal replacement therapy
Appears in Collections:Journal articles

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