Abstract

INTRODUCTION

The incidence of acute kidney injury (AKI) in intensive care units (ICU) has been increasing due to increasing age, multiple associated co-morbidities, application of invasive procedures, and high disease-severity scores. The impact of choice of a convenient and effective renal replacement therapy (RRT) modality is utmost importance. So far there has been no clear concensus on the choice of RRT modality. This study was conducted to estimate the predictive factors that determine the clinician’s choice of initial RRT modality in ICU-AKI patients.

METHODS

Between January 2016 and December 2017 the patients admitted to ICU more than three days who developed AKI were recruited. The data was obtained retrospectively from electronical data system and included demographics, clinical, and laboratory features. According to choice of initial RRT modality patients were divided into two groups; intermittant hemodialysis (HD) and continuous venovenous hemodiafiltration (CVVHDF) groups. The factors that determined the modality choice was analyzed by logistic regression. In-hospital mortality rate was calculated regarding the type of modality.

RESULTS

Out of 1806 patients admitted to ICU 171 patients (9.46%, 97 males, 74 females, mean age of 67.47±15.60 years) developed AKI requiring RRT. The mean hospital stay was 8.41±10.26 days. Between HD (n=93, 54.1%) and CVVHDF (n=78, 45.3%) groups age, gender, associated co-morbidities and hospital-stay days did not differ significantly. Logistic regression analysis revealed that sepsis and cardiological disorders, mean arterial pressure (MAP) <75 mmHg, high SAPS II scores, use of vasopressors and inotropes, high lactate levels, and urinary output of <0.25 ml/kg/h were associated with the choice of CRRT.

DISCUSSION AND CONCLUSION

The factors suggesting the choice of RRT modality type in ICU are not clear. We emphasized that some parameters related to patient’s demographics, clinics and laboratory data affect the clinician’s choice.