The effect of timing of initiation of renal replacement therapy on mortality: A retrospective case–control study

Milo Engoren; Michael D Maile; Michael Heung; James M Blum; Ross Blank; Lena M Napolitano; Pauline K Park; Krishnan Raghavendran; Elizabeth S Jewell; Craig Meldrum

doi:10.1177/1751143719892792

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The effect of timing of initiation of renal replacement therapy on mortality: A retrospective case–control study

Journal article

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The effect of timing of initiation of renal replacement therapy on mortality: A retrospective case–control study

Milo Engoren, Michael D Maile, Michael Heung, James M Blum, Ross Blank, Lena M Napolitano, Pauline K Park, Krishnan Raghavendran, Elizabeth S Jewell and Craig Meldrum

Journal of the Intensive Care Society, Vol.22(1), pp.8-16

2021

DOI: 10.1177/1751143719892792

PMCID: PMC7890751

PMID: 33643427

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Abstract

Purpose To determine if earlier initiation of renal replacement therapy (RRT) is associated with improved survival in patients with severe acute kidney injury. Methods We performed a retrospective case–control study of propensity-matched groups with multivariable logistic regression using Akaike Information Criteria to adjust for non-matched variables in a surgical ICU in a tertiary care hospital. Results We matched 169 of 205 (82%) patients with new initiation of RRT (EARLY group) to 169 similar patients who did not initiate RRT on that day (DEFERRED group). Eighteen (11%) of DEFERRED eventually received RRT before discharge. By univariate analysis, ICU mortality was higher in EARLY (n = 60 (36%) vs. n = 23 (14%), p < 0.001) as was hospital mortality (n = 73 (43%) vs. n = 44 (26%), p = 0.001). Of the 18 RRT patients in DEFERRED, 12 (67%) died in ICU and 13 (72%) in hospital. After propensity matching and logistic regression, we found that EARLY initiation of RRT was associated with a more than doubling of ICU mortality (aOR = 2.310, 95% confidence interval = 1.254–4.257, p = 0.007). However, after similar adjustment, there was no difference in hospital mortality (aOR = 1.283, 95% CI = 0.753–2.186, p = 0.360). Conclusions While ICU mortality was increased in the EARLY group, there was no difference in hospital mortality between EARLY and DEFERRED groups.

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Title: Subtitle: The effect of timing of initiation of renal replacement therapy on mortality: A retrospective case–control study
Creators: Milo Engoren - Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
Michael D Maile - Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
Michael Heung - Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
James M Blum - Department of Anesthesiology, Emory University, Atlanta, GA, USA
Ross Blank - Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
Lena M Napolitano - Department of Surgery, University of Michigan, Ann Arbor, MI, USA
Pauline K Park - Department of Surgery, University of Michigan, Ann Arbor, MI, USA
Krishnan Raghavendran - Department of Surgery, University of Michigan, Ann Arbor, MI, USA
Elizabeth S Jewell - Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
Craig Meldrum - Department of Surgery, University of Michigan, Ann Arbor, MI, USA
Resource Type: Journal article
Publication Details: Journal of the Intensive Care Society, Vol.22(1), pp.8-16
DOI: 10.1177/1751143719892792
PMID: 33643427
PMCID: PMC7890751
ISSN: 1751-1437
eISSN: 2057-360X
Language: English
Date published: 2021
Academic Unit: Anesthesia
Record Identifier: 9984013161602771

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