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

Zachary O'Brien, Alan Cass, Louise Cole, Simon Finfer, Martin Gallagher, Colin McArthur, Shay McGuiness, John Myburgh, Rinaldo Bellomo, Johan Mårtensson, on behalf of the RENAL Study Investigators and the Australian and New Zealand Intensive Care Clinical Trials Group

Research output: Contribution to journalArticleResearchpeer-review

5 Citations (Scopus)

Abstract

Aims: 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. Methods: 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. Results: 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). Conclusions: In RENAL patients with liver dysfunction, higher CRRT intensity was not associated with reduced mortality.

Original languageEnglish
Pages (from-to)36-43
Number of pages8
JournalBlood Purification
Volume45
Issue number1-3
DOIs
Publication statusPublished - 2018

Keywords

  • Acute kidney injury
  • Continuous renal replacement therapy
  • Liver dysfunction
  • Mortality

Cite this