TY - JOUR
T1 - Association between Net Ultrafiltration Rate and Renal Recovery among Critically Ill Adults with Acute Kidney Injury Receiving Continuous Renal Replacement Therapy
T2 - An Observational Cohort Study
AU - Murugan, Raghavan
AU - Kerti, Samantha J.
AU - Chang, Chung Chou H.
AU - Gallagher, Martin
AU - Neto, Ary Serpa
AU - Clermont, Gilles
AU - Ronco, Claudio
AU - Palevsky, Paul M.
AU - Kellum, John A.
AU - Bellomo, Rinaldo
N1 - Funding Information:
Partial support for this work was provided from the National Institute of Diabetes and Digestive and Renal Diseases (5R01DK106256).
Funding Information:
Dr. Murugan reported receiving grants and personal fees from La Jolla Inc.; grants from Bioporto, Inc. and the National Institute of Diabetes and Digestive and Renal Diseases; and personal fees from Beckman Coulter and AM Pharma, Inc., outside the submitted work. Dr. Chang reported receiving grants from the National Institutes of Health during the conduct of the study. Dr. Gallagher reported receiving speaking fees from Amgen outside the submitted work. Dr. Clermont reported receiving personal fees from UpToDate and grants from the National Institutes of Health and the National Science Foundation outside the submitted work. Dr. Ronco reported receiving consulting fees or participating in advisory boards in the last 3 years for ASAHI, Astute, Baxter, Biomerieux, B. Braun, Cytosorbents, ESTOR, FMC, GE, Jafron, Medtronic, and Toray. Dr. Palevsky reported receiving personal fees from Novartis, GE Healthcare, HealthSpan Dx, and Baxter International and grants from Dascena outside the submitted work. Dr. Kellum reported receiving personal fees from NxStage and grants and personal fees from Baxter International during the conduct of the study. Dr. Bellomo reported receiving grants from Baxter International outside the submitted work.
Publisher Copyright:
© 2021 S. Karger AG. All rights reserved.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/7/21
Y1 - 2021/7/21
N2 - Introduction: Higher net ultrafiltration (UFNET) rates are associated with mortality among critically ill patients with acute kidney injury (AKI) and treated with continuous renal replacement therapy (CRRT). Objective: The aim of the study was to discover whether UFNET rates are associated with renal recovery and independence from renal replacement therapy (RRT). Methods: Retrospective cohort study using data from the Randomized Evaluation of Normal versus Augmented Level of Renal Replacement Therapy trial that enrolled 1,433 critically ill patients with AKI and treated with CRRT between December 2005 and November 2008 across 35 intensive care units in Australia and New Zealand. We examined the association between UFNET rate and time to independence from RRT by day 90 using competing risk regression after accounting for mortality. The UFNET rate was defined as the volume of fluid removed per hour adjusted for patient body weight. Results and Conclusions: Median age was 67.3 (interquartile range [IQR], 57-76.3) years, 64.4% were male, median Acute Physiology and Chronic Health Evaluation-III score was 100 (IQR, 84-118), and 634 (44.2%) died by day 90. Kidney recovery occurred in 755 patients (52.7%). Using tertiles of UFNET rates, 3 groups were defined: high, >1.75; middle, 1.01-1.75; and low, <1.01 mL/kg/h. Proportion of patients alive and independent of RRT among the groups were 47.8 versus 57.2 versus 53.0%; p = 0.01. Using competing risk regression, higher UFNET rate tertile compared with middle (cause-specific hazard ratio [csHR], 0.79, 95% CI, 0.66-0.95; subdistribution hazard ratio [sHR], 0.80, 95% CI, 0.67-0.97) and lower (csHR, 0.69, 95% CI, 0.56-0.85; sHR, 0.78, 95% CI 0.64-0.95) tertiles were associated with a longer time to independence from RRT. Every 1.0 mL/kg/h increase in rate was associated with a lower probability of kidney recovery (csHR, 0.81, 95% CI, 0.74-0.89; and sHR, 0.87, 95% CI, 0.80-0.95). Using the joint model, longitudinal increases in UFNET rates were also associated with a lower renal recovery (β =-0.29, p < 0.001). UFNET rates >1.75 mL/kg/h compared with rates 1.01-1.75 and <1.01 mL/kg/h were associated with a longer duration of dependence on RRT. Randomized clinical trials are required to confirm this UFNET rate-outcome relationship.
AB - Introduction: Higher net ultrafiltration (UFNET) rates are associated with mortality among critically ill patients with acute kidney injury (AKI) and treated with continuous renal replacement therapy (CRRT). Objective: The aim of the study was to discover whether UFNET rates are associated with renal recovery and independence from renal replacement therapy (RRT). Methods: Retrospective cohort study using data from the Randomized Evaluation of Normal versus Augmented Level of Renal Replacement Therapy trial that enrolled 1,433 critically ill patients with AKI and treated with CRRT between December 2005 and November 2008 across 35 intensive care units in Australia and New Zealand. We examined the association between UFNET rate and time to independence from RRT by day 90 using competing risk regression after accounting for mortality. The UFNET rate was defined as the volume of fluid removed per hour adjusted for patient body weight. Results and Conclusions: Median age was 67.3 (interquartile range [IQR], 57-76.3) years, 64.4% were male, median Acute Physiology and Chronic Health Evaluation-III score was 100 (IQR, 84-118), and 634 (44.2%) died by day 90. Kidney recovery occurred in 755 patients (52.7%). Using tertiles of UFNET rates, 3 groups were defined: high, >1.75; middle, 1.01-1.75; and low, <1.01 mL/kg/h. Proportion of patients alive and independent of RRT among the groups were 47.8 versus 57.2 versus 53.0%; p = 0.01. Using competing risk regression, higher UFNET rate tertile compared with middle (cause-specific hazard ratio [csHR], 0.79, 95% CI, 0.66-0.95; subdistribution hazard ratio [sHR], 0.80, 95% CI, 0.67-0.97) and lower (csHR, 0.69, 95% CI, 0.56-0.85; sHR, 0.78, 95% CI 0.64-0.95) tertiles were associated with a longer time to independence from RRT. Every 1.0 mL/kg/h increase in rate was associated with a lower probability of kidney recovery (csHR, 0.81, 95% CI, 0.74-0.89; and sHR, 0.87, 95% CI, 0.80-0.95). Using the joint model, longitudinal increases in UFNET rates were also associated with a lower renal recovery (β =-0.29, p < 0.001). UFNET rates >1.75 mL/kg/h compared with rates 1.01-1.75 and <1.01 mL/kg/h were associated with a longer duration of dependence on RRT. Randomized clinical trials are required to confirm this UFNET rate-outcome relationship.
KW - Acute kidney injury
KW - Competing risk
KW - Kidney replacement therapy
KW - Net ultrafiltration
KW - Renal recovery
UR - https://www.scopus.com/pages/publications/85111594978
U2 - 10.1159/000517281
DO - 10.1159/000517281
M3 - Article
C2 - 34289471
AN - SCOPUS:85111594978
SN - 0253-5068
VL - 51
SP - 397
EP - 409
JO - Blood Purification
JF - Blood Purification
ER -