Renal Replacement Therapy in Patients With Stage IV Cancer Admitted to the Intensive Care Unit With Acute Kidney Injury at a Comprehensive Cancer Center Was Not Associated With Survival

Hospital mortality and prognostic factors in critically ill patients with acute kidney injury and cancer undergoing continuous renal replacement therapy

BACKGROUND

Whether continuous renal replacement therapy (CRRT) should be applied to critically ill patients with both acute kidney injury (AKI) and cancer remains controversial because of poor expected outcomes. The present study determined prognostic factors for all-cause in-hospital mortality in patients with AKI and cancer undergoing CRRT.

METHODS

We included 471 patients with AKI and cancer who underwent CRRT at the intensive care unit of a Korean tertiary hospital from 2013 to 2020, and classified them by malignancy type. The primary outcomes were 28-day all-cause mortality rate and prognostic factors for in-hospital mortality. The secondary outcome was renal replacement therapy (RRT) dependency at hospital discharge.

RESULTS

The 28-day mortality rates were 58.8% and 82% in the solid and hematologic malignancy groups, respectively. Body mass index (BMI), presence of oliguria, Sequential Organ Failure Assessment (SOFA) score, and albumin level were common predictors of 28-day mortality in the solid and hematologic malignancy groups. A high heart rate and the presence of severe acidosis were prognostic factors only in the solid malignancy group. Among the survivors, the proportion with RRT dependency was 25.0% and 33.3% in the solid and hematologic malignancy groups, respectively.

CONCLUSION

The 28-day mortality rate of cancer patients with AKI undergoing CRRT was high in both the solid and hematologic malignancy groups. BMI, presence of oliguria, SOFA score, and albumin level were common predictors of 28-day mortality in the solid and hematologic malignancy groups, but a high heart rate and severe acidosis were prognostic factors only in the solid malignancy group.

Determinants of Outcomes of Acute Kidney Injury: Clinical Predictors and Beyond

Acute kidney injury (AKI) is a common clinical syndrome characterized by rapid impairment of kidney function. The incidence of AKI and its severe form AKI requiring dialysis (AKI-D) has been increasing over the years. AKI etiology may be multifactorial and is substantially associated with increased morbidity and mortality. The outcome of AKI-D can vary from partial or complete recovery to transitioning to chronic kidney disease, end stage kidney disease, or even death. Predicting outcomes of patients with AKI is crucial as it may allow clinicians to guide policy regarding adequate management of this problem and offer the best long-term options to their patients in advance. In this manuscript, we will review the current evidence regarding the determinants of AKI outcomes, focusing on AKI-D.

Use of matching methods in observational studies with critical patients and renal outcomes. Scoping review

Introduction: The use of matching techniques in observational studies has been increasing and is not always used appropriately. Clinical experiments are not always feasible in critical patients with renal outcomes, and observational studies are an important alternative. Objective: Through a scoping review, determine the available evidence on the use of matching methods in studies involving critically ill patients and assessing renal outcomes. Methods: Medline, Embase, and Cochrane databases were used to identify articles published between 1992 and 2020 up to week 10, which studied different exposures in the critically ill patient with renal outcomes and used propensity matching methods. Results: Most publications are cohort studies 94 (94. 9 %), five studies (5. 1 %) were cross-sectional. The main pharmacological intervention was the use of antibiotics in seven studies (7. 1%) and the main risk factor studied was renal injury prior to ICU admission in 10 studies (10. 1%). The balance between the baseline characteristics assessed by standardized means, in only 28 studies (28. 2%). Most studies 95 (96 %) used logistic regression to calculate the propensity index. Conclusion: Major inconsistencies were observed in the use of methods and in the reporting of findings. A summary is made of the aspects to be considered in the use of the methods and reporting of the findings with the matching by propensity index.

Effect of renal support therapy on 5-year survival in patients discharged from the intensive care unit

Background

Between 30 and 70% of patients admitted to the intensive care unit (ICU) have acute kidney injury (AKI), and 10% of these patients will require renal replacement therapy (RRT). A significant number of studies have compared the mortality of patients who require RRT versus those who do not require it, finding an increase in mortality rates in the short and medium term; however, few studies have evaluated the long-term survival in a mixture of patients admitted to the ICU.

Objective

To evaluate the impact of RRT on 5-year survival in patients with AKI admitted to the ICU.

Methods

Using administrative databases of insurers of the Colombian health system, a cohort of patients admitted to the ICU between 1 January 2012 and 31 December 2013 was followed until 31 December 2018. ICD-10 diagnoses, procedure codes, and prescribed medications were used to establish the frequencies of the comorbidities included in the Charlson index. Patients were followed for at least 5 years to evaluate survival and establish the adjusted risks by propensity score matching.

Results

Of the 150,230 patients admitted to the ICU, 4366 (2.9%) required RRT in the ICU. Mortality rates for patients with RRT vs no RRT evaluated at ICU discharge, 1 year, and 5 years were 35%, 57.4%, and 67.9% vs 7.4%, 17.6%, and 30.1%, respectively. After propensity score matching, the hazard ratio was calculated for patients who received RRT and those who did not (HR, 2.46; 95% CI 2.37 to 2.56; p < 0.001), with a lower difference in years of survival for patients with RRT (mean effect in the treated) of - 1.86 (95% CI - 2.01 to to1.65; p < 0.001).

Conclusions

The impact of acute renal failure with the consequent need for RRT in patients admitted to the ICU is reflected in a decrease of approximately one quarter in 5-year survival, regardless of the different comorbidities.