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Yasuda H, Horikoshi Y, Kamoshita S, Kuroda A, Moriya T. Associations between In-Hospital Mortality and Prescribed Parenteral Energy and Amino Acid Doses in Critically Ill Patients: A Retrospective Cohort Study Using a Medical Claims Database. Nutrients 2023; 16:57. [PMID: 38201887 PMCID: PMC10781052 DOI: 10.3390/nu16010057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Some critically ill patients completely rely on parenteral nutrition (PN), which often cannot provide sufficient energy/amino acids. We investigated the relationship between PN doses of energy/amino acids and clinical outcomes in a retrospective cohort study using a medical claims database (≥10.5 years, from Japan, and involving 20,773 adult intensive care unit (ICU) patients on mechanical ventilation and exclusively receiving PN). Study patients: >70 years old, 63.0%; male, 63.3%; and BMI < 22.5, 56.3%. Initiation of PN: third day of ICU admission. PN duration: 12 days. In-hospital mortality: 42.5%. Patients were divided into nine subgroups based on combinations of the mean daily doses received during ICU days 4-7: (1) energy (very low <10 kcal/kg/day; low ≥10, <20; and moderate ≥20); (2) amino acids (very low <0.3 g/kg/day; low ≥0.3, <0.6; and moderate ≥0.6). For each subgroup, adjusted odds ratios (AORs) of in-hospital mortality with 95% confidence intervals (CIs) were calculated by regression analysis. The highest odds of mortality among the nine subgroups was in the moderate calorie/very low amino acid (AOR = 2.25, 95% CI 1.76-2.87) and moderate calorie/low amino acid (AOR = 1.68, 95% CI 1.36-2.08) subgroups, meaning a significant increase in the odds of mortality by between 68% and 125% when an amino acid dose of <0.6 g/kg/day was prescribed during ICU days 4-7, even when ≥20 kcal/kg/day of calories was prescribed. In conclusion, PN-dependent critically ill patients may have better outcomes including in-hospital mortality when ≥0.6 g/kg/day of amino acids is prescribed.
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Affiliation(s)
- Hideto Yasuda
- Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Ohmiya-ku, Saitama 330-0834, Japan;
| | - Yuri Horikoshi
- Medical Affairs Department, Research and Development Center, Otsuka Pharmaceutical Factory, Inc., 2-9 Kandatsukasa-machi, Chiyoda-ku, Tokyo 101-0048, Japan; (Y.H.); (S.K.)
| | - Satoru Kamoshita
- Medical Affairs Department, Research and Development Center, Otsuka Pharmaceutical Factory, Inc., 2-9 Kandatsukasa-machi, Chiyoda-ku, Tokyo 101-0048, Japan; (Y.H.); (S.K.)
| | - Akiyoshi Kuroda
- Research and Development Center, Otsuka Pharmaceutical Factory, Inc., 2-9 Kandatsukasa-machi, Chiyoda-ku, Tokyo 101-0048, Japan;
| | - Takashi Moriya
- Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Ohmiya-ku, Saitama 330-0834, Japan;
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Xun K, Qiu H, Jia M, Lin L, He M, Li D, Jin D. Treatment Effect of Regional Sodium Citrate Anticoagulation in Elderly Patients With High-Risk Bleeding Receiving Continuous Renal Replacement Therapy. Clin Appl Thromb Hemost 2021; 27:10760296211050640. [PMID: 34719982 PMCID: PMC8559185 DOI: 10.1177/10760296211050640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective To investigate the safety and efficacy of regional citrate anticoagulation (RCA) on elderly patients at high risk of bleeding after continuous renal replacement therapy (CRRT). Methods A total of 31 patients at high risk of bleeding who received CRRT in the intensive care unit were collected. The patients were divided into RCA group (n = 17) and no anticoagulation group (NA, n = 14) according to whether RCA was used or not. The levels of creatinine (Cr), blood urea nitrogen (BUN), prothrombin time (PT), activated partial thromboplastin time (APTT), total calcium (tCa), ionized calcium ion (iCa2+), sodium ion (Na+), bicarbonate ion (HCO3−), tCa/iCa2+ ratio, and pH were observed after treatment. The filter use time, number of filters used, filter obstruction events, clinical outcomes, and safety evaluation indexes were compared post-treatment. Results After treatment, serum Cr and BUN levels, APTT and PT levels in the RCA group were significantly lower than the NA group. The tCa, iCa2+, HCO3−, tCa/iCa2+, and pH were within the normal range after RCA treatment while Na+ levels saw a significant increase. In the RCA group, the filter using time was significantly longer, with significantly reduced numbers of filter use within 72 h and filter disorder events. Additionally, patients in the RCA group showed significant recovery of renal function and a significant reduction in bleeding events and in-hospital mortality. Conclusion RCA treatment significantly improves clinical outcome of patients at high risk of bleeding after CRRT, safely and effectively prolongs the filter life and avoids coagulation incidences.
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Affiliation(s)
- Kang Xun
- The People's Hospital of Suzhou New District, Suzhou, China
| | - Hong Qiu
- The People's Hospital of Suzhou New District, Suzhou, China
| | - Miao Jia
- The People's Hospital of Suzhou New District, Suzhou, China
| | - Lihua Lin
- The People's Hospital of Suzhou New District, Suzhou, China
| | - Meiling He
- The People's Hospital of Suzhou New District, Suzhou, China
| | - Damei Li
- The People's Hospital of Suzhou New District, Suzhou, China
| | - Donghua Jin
- The People's Hospital of Suzhou New District, Suzhou, China
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Zheng LJ, Jiang W, Pan L, Pan J. Reduced serum albumin as a risk factor for poor prognosis in critically ill patients receiving renal replacement therapy. BMC Nephrol 2021; 22:305. [PMID: 34496793 PMCID: PMC8427850 DOI: 10.1186/s12882-021-02512-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/27/2021] [Indexed: 01/17/2023] Open
Abstract
Background Albumin is the primary body protein, which can predict the poor prognosis of several critical diseases. However, there are a few scientific studies on the relationship between albumin and the prognosis of dialysis patients. This study aims to explore the impact of hypoalbuminemia on the prognosis of critically ill patients with acute kidney injury (AKI) receiving continuous renal replacement therapy (CRRT). Methods This was a secondary study. Clinical, biochemical, and 28-day and 90-day mortality rates for critical patients with AKI who received CRRT between 2009 and 2016 were searched from the database to determine the effect of hypoalbuminemia on poor outcomes by univariate, multivariate, smooth curve fitting, and subgroup analysis. Results A total of 837 participants were enrolled in this study. Multivariate Cox proportional hazard regression analysis showed that hypoalbuminemia was associated with both 28-day and 90-day mortality risks after full adjustment for confounding variables, with an adjusted hazard ratio (95% confidence interval) of 0.63 (0.50–0.80) and 0.63 (0.51–0.78), respectively for each 1 g/dL increase of albumin. Stratified analysis showed that hypoalbuminemia was not associated with poor prognosis in oliguria. Conclusion Hypoalbuminemia is associated with poor prognosis in critically ill AKI patients with CRRT; therefore, measuring albumin may be helpful for predicting the prognosis. However, in those with oliguria, this conclusion is not valid.
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Affiliation(s)
- Lang Jing Zheng
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People's Republic of China
| | - Weiming Jiang
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People's Republic of China
| | - Lingling Pan
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People's Republic of China
| | - Jingye Pan
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People's Republic of China.
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Lim JH, Jeon Y, Ahn JS, Kim S, Kim DK, Lee JP, Ryu DR, Seong EY, Ahn SY, Baek SH, Jung HY, Choi JY, Park SH, Kim CD, Kim YL, Cho JH. GDF-15 Predicts In-Hospital Mortality of Critically Ill Patients with Acute Kidney Injury Requiring Continuous Renal Replacement Therapy: A Multicenter Prospective Study. J Clin Med 2021; 10:jcm10163660. [PMID: 34441955 PMCID: PMC8397174 DOI: 10.3390/jcm10163660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 02/01/2023] Open
Abstract
Growth differentiation factor-15 (GDF-15) is a stress-responsive cytokine. This study evaluated the association between GDF-15 and in-hospital mortality among patients with severe acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). Among the multicenter prospective CRRT cohort between 2017 and 2019, 66 patients whose blood sample was available were analyzed. Patients were divided into three groups according to the GDF-15 concentrations. The median GDF-15 level was 7865.5 pg/mL (496.9 pg/mL in the healthy control patients). Baseline characteristics were not different among tertile groups except the severity scores and serum lactate level, which were higher in the third tertile. After adjusting for confounding factors, the patients with higher GDF-15 had significantly increased risk of mortality (second tertile: adjusted hazards ratio [aHR], 3.67; 95% confidence interval [CI], 1.05-12.76; p = 0.041; third tertile: aHR, 6.81; 95% CI, 1.98-23.44; p = 0.002). Furthermore, GDF-15 predicted in-hospital mortality (area under the curve, 0.710; 95% CI, 0.585-0.815) better than APACHE II and SOFA scores. Serum GDF-15 concentration was elevated in AKI patients requiring CRRT, higher in more severe patients. GDF-15 is a better independent predictor for in-hospital mortality of critically ill AKI patients than the traditional risk scoring system such as APACHE II and SOFA scores.
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Affiliation(s)
- Jeong-Hoon Lim
- Department of Internal Medicine, Division of Nephrology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (J.-S.A.); (H.-Y.J.); (J.-Y.C.); (S.-H.P.); (C.-D.K.); (Y.-L.K.)
- Correspondence: (J.-H.L.); (J.-H.C.); Tel.: +82-53-200-3209 (J.-H.L.); +82-53-200-5550 (J.-H.C.); Fax: +82-53-426-9464 (J.-H.L.); +82-53-426-2046 (J.-H.C.)
| | - Yena Jeon
- Department of Statistics, Kyungpook National University, Daegu 41566, Korea;
| | - Ji-Sun Ahn
- Department of Internal Medicine, Division of Nephrology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (J.-S.A.); (H.-Y.J.); (J.-Y.C.); (S.-H.P.); (C.-D.K.); (Y.-L.K.)
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea;
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 08826, Korea; (D.K.K.); (J.P.L.)
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 08826, Korea; (D.K.K.); (J.P.L.)
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul 07061, Korea
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul 07804, Korea;
| | - Eun Young Seong
- Division of Nephrology, Pusan National University School of Medicine, Busan 50612, Korea;
| | - Shin Young Ahn
- Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Korea;
| | - Seon Ha Baek
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Korea;
| | - Hee-Yeon Jung
- Department of Internal Medicine, Division of Nephrology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (J.-S.A.); (H.-Y.J.); (J.-Y.C.); (S.-H.P.); (C.-D.K.); (Y.-L.K.)
| | - Ji-Young Choi
- Department of Internal Medicine, Division of Nephrology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (J.-S.A.); (H.-Y.J.); (J.-Y.C.); (S.-H.P.); (C.-D.K.); (Y.-L.K.)
| | - Sun-Hee Park
- Department of Internal Medicine, Division of Nephrology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (J.-S.A.); (H.-Y.J.); (J.-Y.C.); (S.-H.P.); (C.-D.K.); (Y.-L.K.)
| | - Chan-Duck Kim
- Department of Internal Medicine, Division of Nephrology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (J.-S.A.); (H.-Y.J.); (J.-Y.C.); (S.-H.P.); (C.-D.K.); (Y.-L.K.)
| | - Yong-Lim Kim
- Department of Internal Medicine, Division of Nephrology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (J.-S.A.); (H.-Y.J.); (J.-Y.C.); (S.-H.P.); (C.-D.K.); (Y.-L.K.)
| | - Jang-Hee Cho
- Department of Internal Medicine, Division of Nephrology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (J.-S.A.); (H.-Y.J.); (J.-Y.C.); (S.-H.P.); (C.-D.K.); (Y.-L.K.)
- Correspondence: (J.-H.L.); (J.-H.C.); Tel.: +82-53-200-3209 (J.-H.L.); +82-53-200-5550 (J.-H.C.); Fax: +82-53-426-9464 (J.-H.L.); +82-53-426-2046 (J.-H.C.)
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Srisawat N, Chakravarthi R. CRRT in developing world. Semin Dial 2021; 34:567-575. [PMID: 33955593 DOI: 10.1111/sdi.12975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/10/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
Continuous renal replacement therapy (CRRT) has become a mainstay therapy in the intensive care unit (ICU) and its utilization continues to increase in developed countries. The wide variations of CRRT practice, however, are evident in developing countries while clinicians in these resource-limited countries encounter various barriers such as a limited number of nephrologists and trained staff, a gap of knowledge, machine unavailability, cultural and socioeconomic aspects, high-cost therapy without reimbursement, and administrative as well as governmental barriers. In this article, we demonstrate the situation of CRRT and discuss the barriers of CRRT in a resource-limited setting. We also discuss the strategies to improve CRRT practice. These recommendations can serve as a fundamental guideline for clinicians to implement CRRT in low-resource settings.
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Affiliation(s)
- Nattachai Srisawat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Department of Critical Care Medicine, Center for Critical Care Nephrology, The CRISMA Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Critical Care Nephrology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Academy of Science, Royal Society of Thailand, Bangkok, Thailand.,Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand
| | - Rajasekara Chakravarthi
- Renown Clinical Services, Hyderabad, India.,STAR Kidney Center, Star Hospitals, Hyderabad, India
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Abstract
Acute kidney injury (AKI) is a threatening medical condition associated with poor outcomes at different settings. The development of standardized diagnostic criteria and new biomarkers addressed significant clinical impacts of AKI and the need for an early AKI detection, respectively. There have been some breakthroughs in understanding the pathogenesis of AKI through basic research; however, treatments against AKI aside from renal replacement therapy (RRT) have not shown adequate successful results. Biomarkers that could identify good responders to certain treatment are expected to facilitate translation of basic research findings. Most patients with severe AKI treated with RRT died due to multiple-organ failure, not renal dysfunction. Hence, it is essential to identify other organ dysfunctions induced by AKI as organ crosstalk. Also, a multidisciplinary approach of critical care nephrology is needed to evaluate a complex organ crosstalk in AKI. For disruptive innovation for AKI, we further explore these new aspects of AKI, which previously were considered outside the scope of nephrology.
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Affiliation(s)
- Kent Doi
- Department of Emergency and Critical Care Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan.
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Abstract
Acute kidney injury (AKI) is a critical burden on intensive care units in Asia. Renal replacement therapy (RRT) acts as strong supportive care for severe AKI. However, various RRT modalities are used in Asia because of the diversity in ethics, climate, geographic features, and socioeconomic status. Extracorporeal blood purification is used commonly in Asian intensive care units; however, intermittent RRT is preferred in developing countries because of cost and infrastructure issues. Conversely, continuous RRT is preferred in developed countries, indicating the predominance of hospital-acquired AKI patients with complications of hemodynamic instability. Peritoneal dialysis is delivered less frequently, although several studies have suggested promising results for peritoneal dialysis in AKI treatment. Of note, not all RRT modalities are available as a standard procedure in some Asian regions, and it is absolutely necessary to develop a sustainable infrastructure that can deliver optimal care for all AKI patients.
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Affiliation(s)
- Ryo Matsuura
- Department of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
| | - Kent Doi
- Department of Emergency and Critical Care and Medicine, The University of Tokyo Hospital, Tokyo, Japan.
| | - Yoshifumi Hamasaki
- Department of Hemodialysis and Apheresis, The University of Tokyo, Tokyo, Japan
| | - Masaomi Nangaku
- Department of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
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8
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Moon JJ, Kim Y, Kim DK, Joo KW, Kim YS, Han SS. Association of hypoalbuminemia with short-term and long-term mortality in patients undergoing continuous renal replacement therapy. Kidney Res Clin Pract 2020; 39:47-53. [PMID: 31995708 PMCID: PMC7105631 DOI: 10.23876/j.krcp.19.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/21/2019] [Accepted: 11/19/2019] [Indexed: 01/09/2023] Open
Abstract
Background Hypoalbuminemia reflects several pathological conditions, including nutritional deficiencies and chronic inflammation. However, its relationship with short-term and long-term mortality in patients undergoing continuous renal replacement therapy (CRRT) remains unclear. The present study aimed to assess the effect of hypoalbuminemia on mortality in a large cohort of patients undergoing CRRT. Methods The study retrospectively reviewed 1,581 patients who underwent CRRT for the treatment of acute kidney injury from 2010 to 2016. The patients were categorized by tertiles of serum albumin levels at CRRT initiation. The odds ratios and hazard ratios for the risk of all-cause mortality were calculated before and after adjustment for multiple covariates. Results The mean albumin level was 2.7 ± 0.6 g/dL at CRRT initiation. During a median follow-up period of 14 days (maximum, 4 years), 1,040 patients (65.8%) died. The risk of overall mortality was higher in the first tertile group than in the third tertile group (hazard ratio, 1.9 [1.63-2.21]). When the mortality rate was stratified by timeframe, the risk was steadily higher in the first tertile group than in the third tertile group (odds ratios: 3.0 [2.34-3.87] for 2-week mortality, 2.7 [2.12-3.52] for 1-month mortality, 2.7 [2.08-3.53] for 6-month mortality, and 2.8 [2.11-3.62] for 1-year mortality). Additionally, the rates of intensive care unit mortality and in-hospital mortality were higher in the first tertile group than in the third tertile group. Conclusion The initial hypoalbuminemia was independently associated with short-term and long-term mortality in patients undergoing CRRT. Thus, the serum albumin level should be monitored during CRRT.
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Affiliation(s)
- Jong Joo Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yaerim Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Naruse H, Ishii J, Takahashi H, Kitagawa F, Nishimura H, Kawai H, Muramatsu T, Harada M, Yamada A, Fujiwara W, Hayashi M, Motoyama S, Sarai M, Watanabe E, Izawa H, Ozaki Y. Urinary Liver-Type Fatty-Acid-Binding Protein Predicts Long-Term Adverse Outcomes in Medical Cardiac Intensive Care Units. J Clin Med 2020; 9:jcm9020482. [PMID: 32050627 PMCID: PMC7073895 DOI: 10.3390/jcm9020482] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 12/14/2022] Open
Abstract
We prospectively investigated the prognostic value of urinary liver-type fatty-acid-binding protein (L-FABP) levels on hospital admission, both independently and in combination with serum creatinine-defined acute kidney injury (AKI), to predict long-term adverse outcomes in 1119 heterogeneous patients (mean age; 68 years) treated at medical (non-surgical) cardiac intensive care units (CICUs). Patients with stage 5 chronic kidney disease were excluded from the study. Of these patients, 47% had acute coronary syndrome and 38% had acute decompensated heart failure. The creatinine-defined AKI was diagnosed according to the "Kidney Disease: Improving Global Outcomes" criteria. The primary endpoint was a composite of all-cause death or progression to end-stage kidney disease, indicating the initiation of maintenance dialysis therapy or kidney transplantation. Creatinine-defined AKI occurred in 207 patients, with 44 patients having stage 2 or 3 disease. During a mean follow-up period of 41 months after enrollment, the primary endpoint occurred in 242 patients. Multivariate Cox regression analyses revealed L-FABP levels as independent predictors of the primary endpoint (p < 0.001). Adding L-FABP to a baseline model with established risk factors further enhanced reclassification and discrimination beyond that of the baseline model alone, for primary-endpoint prediction (both; p < 0.01). On Kaplan-Meier analyses, increased L-FABP (≥4th quintile value of 9.0 ng/mL) on admission or presence of creatinine-defined AKI, correlated with an increased risk of the primary endpoint (p < 0.001). Thus, urinary L-FABP levels on admission are potent and independent predictors of long-term adverse outcomes, and they might improve the long-term risk stratification of patients admitted at medical CICUs, when used in combination with creatinine-defined AKI.
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Affiliation(s)
- Hiroyuki Naruse
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, Toyoake 470-1192, Japan (F.K.)
| | - Junnichi Ishii
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, Toyoake 470-1192, Japan (F.K.)
- Correspondence: ; Tel.: +81-562-93-2312
| | - Hiroshi Takahashi
- Division of Statistics, Fujita Health University School of Medicine, Toyoake 470-1192, Japan;
| | - Fumihiko Kitagawa
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, Toyoake 470-1192, Japan (F.K.)
| | - Hideto Nishimura
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan (H.K.); (T.M.); (M.H.); (A.Y.); (S.M.); (M.S.); (E.W.)
| | - Hideki Kawai
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan (H.K.); (T.M.); (M.H.); (A.Y.); (S.M.); (M.S.); (E.W.)
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan (H.K.); (T.M.); (M.H.); (A.Y.); (S.M.); (M.S.); (E.W.)
| | - Masahide Harada
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan (H.K.); (T.M.); (M.H.); (A.Y.); (S.M.); (M.S.); (E.W.)
| | - Akira Yamada
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan (H.K.); (T.M.); (M.H.); (A.Y.); (S.M.); (M.S.); (E.W.)
| | - Wakaya Fujiwara
- Department of Cardiology, Bantane Hospital, Nagoya 454-8509, Japan; (W.F.); (M.H.); (H.I.)
| | - Mutsuharu Hayashi
- Department of Cardiology, Bantane Hospital, Nagoya 454-8509, Japan; (W.F.); (M.H.); (H.I.)
| | - Sadako Motoyama
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan (H.K.); (T.M.); (M.H.); (A.Y.); (S.M.); (M.S.); (E.W.)
| | - Masayoshi Sarai
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan (H.K.); (T.M.); (M.H.); (A.Y.); (S.M.); (M.S.); (E.W.)
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan (H.K.); (T.M.); (M.H.); (A.Y.); (S.M.); (M.S.); (E.W.)
| | - Hideo Izawa
- Department of Cardiology, Bantane Hospital, Nagoya 454-8509, Japan; (W.F.); (M.H.); (H.I.)
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan (H.K.); (T.M.); (M.H.); (A.Y.); (S.M.); (M.S.); (E.W.)
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10
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Miyamoto Y, Iwagami M, Aso S, Yasunaga H, Matsui H, Fushimi K, Hamasaki Y, Nangaku M, Doi K. Temporal change in characteristics and outcomes of acute kidney injury on renal replacement therapy in intensive care units: analysis of a nationwide administrative database in Japan, 2007-2016. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:172. [PMID: 31092273 PMCID: PMC6521368 DOI: 10.1186/s13054-019-2468-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/07/2019] [Indexed: 11/18/2022]
Abstract
Background We aimed to examine recent trends in patient characteristics and mortality in patients with acute kidney injury (AKI) receiving renal replacement therapy (RRT), including continuous RRT (CRRT) and intermittent RRT (IRRT), in intensive care units (ICUs). Methods From the Diagnosis Procedure Combination database in Japan during 6 months (July–December) from 2007 to 2016, we identified patients with AKI who received RRT in ICUs. We restricted the study participants to those admitted to hospitals (in which both CRRT and IRRT were available) that participated in the Diagnosis Procedure Combination database for all 10 years. We examined the trends in patient characteristics and mortality overall, by RRT modality, and by main diagnosis category subgroup. Logistic regression was used to adjust for patient characteristics. Results We identified 51,758 patients starting RRT in 287 hospitals, including 39,471 (76.3%) and 12,287 (23.7%) patients starting CRRT and IRRT. The crude in-hospital mortality declined from 44.9 to 36.1% (P for trend < 0.001). Compared with 2007, the adjusted odds ratio (aOR) for in-hospital mortality was 0.66 (95% confidence interval (CI) 0.60–0.72) in 2016, and the decreasing trend was observed in both patients starting CRRT (aOR 0.67, 95% CI 0.61–0.75) and IRRT (0.58, 0.45–0.74), and in all subgroups except for coronary artery disease: sepsis aOR 0.68 (95% CI 0.57–0.81); cardiovascular surgery 0.58 (0.45–0.76); coronary artery disease 0.84 (0.60–1.19); non-coronary heart disease 0.78 (0.64–0.94); central nervous system disorders 0.42 (0.28–0.62); trauma 0.39 (0.21–0.72); and other 0.64 (0.50–0.82). Conclusions This nationwide study confirmed a consistent decline in mortality among patients with AKI on RRT in ICUs. The adjusted mortality also declined during the study period; however, physiological variables were not measured in this study and it is possible that RRT may have been indicated for patients with less severe AKI in more recent years. Electronic supplementary material The online version of this article (10.1186/s13054-019-2468-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yoshihisa Miyamoto
- Division of Nephrology and Endocrinology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Masao Iwagami
- Department of Health Services Research, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shotaro Aso
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Yoshifumi Hamasaki
- Division of Nephrology and Endocrinology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Kent Doi
- Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Acute Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
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11
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Gao J, Wang F, Wang Y, Jin D, Tang L, Pan K. A mode of CVVH with regional citrate anticoagulation compared to no anticoagulation for acute kidney injury patients at high risk of bleeding. Sci Rep 2019; 9:6607. [PMID: 31036927 PMCID: PMC6488647 DOI: 10.1038/s41598-019-42916-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 04/10/2019] [Indexed: 12/21/2022] Open
Abstract
The study was designed to assess a practical mode of postdilution continuous venovenous hemofiltration (CVVH) with regional citrate anticoagulation (RCA) using a calcium-containing replacement solution, and to compare it with a CVVH mode with no anticoagulation (NA). Both methods were employed in our center for acute kidney injury (AKI) patients at high risk of bleeding. Fifty-six patients were equally allocated into the RCA-CVVH group and the NA-CVVH group. The study displayed no significant differences between groups involving baseline characteristics, severity level, blood gas analysis, hepatic/renal/coagulative functions, electrolytes, hemoglobin concentration, and platelet counts before or after continuous renal replacement therapy (CRRT). Compared to the NA-CVVH group, the RCA-CVVH group had a lower level of transfused packed red blood cells and platelet as well as a longer filter lifespan. The result showed no substantial differences between groups in terms of the mean supporting time and cost involving CRRT per person, the length of ICU and hospital stays, and the ICU survival. Homeostasis was basically preserved at a target range during the RCA post-CVVH procedure. Serious complications did not arise during the RCA process. RCA postdilutional CVVH is a safe and effective mode for application in AKI patients with a high risk of bleeding, and it can extend the filter lifespan and decrease blood loss, compared with the NA mode for CRRT. Further studies are needed to evaluate this mode for CRRT. (Retrospective Registration number ChiCTR1800016462, Registration date 2/6/2018)
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Affiliation(s)
- Jianping Gao
- Critical Care Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Feng Wang
- Critical Care Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Yonggang Wang
- Critical Care Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Dan Jin
- Critical Care Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Liping Tang
- Critical Care Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Konghan Pan
- Critical Care Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China.
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12
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Park S, Lee S, Jo HA, Han K, Kim Y, An JN, Joo KW, Lim CS, Kim YS, Kim H, Kim DK. Epidemiology of continuous renal replacement therapy in Korea: Results from the National Health Insurance Service claims database from 2005 to 2016. Kidney Res Clin Pract 2018; 37:119-129. [PMID: 29971207 PMCID: PMC6027810 DOI: 10.23876/j.krcp.2018.37.2.119] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 03/21/2018] [Accepted: 03/27/2018] [Indexed: 11/21/2022] Open
Abstract
Background Continuous renal replacement therapy (CRRT) is an important treatment modality for severe acute kidney injury. As such, the epidemiology of CRRT in Korea needs further investigation. Methods We conducted a nationwide, population-based study analyzing the claims data from National Health Insurance Service of Korea. All index intensive care unit admission cases of CRRT in government-designated tertiary referral hospitals in Korea from 2005 to 2016 were included. Patients with a history of renal replacement therapy or who were under 20 years old were not considered. In addition to baseline and treatment characteristics, patient outcomes, including all-cause mortality and renal survival rates, were investigated. We stratified the study patients according to 3-year time periods and major regions of the nation. Results We included 37,337 patients who received CRRT in Korea. The overall use of CRRT increased over time, and more than 80% of cases of acute renal replacement therapy were CRRT after 2014. Seoul was the region in which the majority of CRRT (45.0%) was performed. The clinical characteristics of CRRT patients were significantly different among time-intervals and regions. Both all-cause mortality and renal survival rates after CRRT were prominently improved in the recent time periods (P < 0.001). Conclusion CRRT is a widely used treatment strategy for severe acute kidney injury in Korea. The prognosis of CRRT patients has improved compared to the past. This epidemiological study of CRRT in Korea revealed notable trends with regard to time period and geographic region.
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Affiliation(s)
- Sehoon Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soojin Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung Ah Jo
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Kyungdo Han
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yaerim Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung Nam An
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yon Su Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyeongsu Kim
- Department of Preventive Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Srisawat N, Sintawichai N, Kulvichit W, Lumlertgul N, Sitticharoenchai P, Thamrongsat N, Peerapornratana S. Current practice of diagnosis and management of acute kidney injury in intensive care unit in resource limited settings. J Crit Care 2018; 46:44-49. [PMID: 29669237 DOI: 10.1016/j.jcrc.2018.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/28/2018] [Accepted: 04/09/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE In a resource limited settings, there is sparse information about the management of acute kidney injury (AKI) based on systemic data collection. This survey aimed to described the current management of AKI in intensive care units (ICUs) across Thailand. MATERIALS AND METHODS Questionnaires were distributed to 160 physicians involved in the intensive care between January and December 2014 across Thailand. Distribution was done through an online survey platform or telephone interview. RESULTS The response rate was 80.6% (129 physicians). AKI diagnosis was mostly made by using KDIGO criteria (36.7%). A common diagnostic investigation of AKI was urinalysis (86%). Nephrologists had a major role (86.4%) in deciding the initiation and selection of renal replacement therapy (RRT) modality. Intermittent hemodialysis is the preferable mode of RRT (72.0%), followed by continuous renal replacement therapy (CRRT, 12%), sustained low efficiency dialysis (10.0%) and peritoneal dialysis (6.0%). Catheter insertion was predominantly performed by nephrologist (51.1%) with ultrasound guidance. The right internal jugular vein was the most common site of insertion (70.4%). The most common indication for CRRT was hemodynamic instability. CONCLUSIONS Amid increasing concern of AKI in the ICU, our study provides the insight into the management of AKI in resource limited settings.
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Affiliation(s)
- Nattachai Srisawat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Center for Critical Care Nephrology, The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
| | - Nattaya Sintawichai
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Win Kulvichit
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Center for Critical Care Nephrology, The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Nuttha Lumlertgul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Patita Sitticharoenchai
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nicha Thamrongsat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sadudee Peerapornratana
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Center for Critical Care Nephrology, The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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14
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Tseng J, Halbert RJ, Minissian N, Rodriguez H, Barathan S, Hain P, Alban RF. Association of Standardization of Continuous Renal Replacement Therapy and High-Value Care: An Evidence-Based Approach. JAMA Intern Med 2018; 178:572-573. [PMID: 29482214 PMCID: PMC5876928 DOI: 10.1001/jamainternmed.2017.8732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This cohort study assesses utilization patterns of continuous renal replacement therapy and attempts to establish evidence-based guidelines to standardize the process flow and to promote meaningful use.
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Affiliation(s)
- Joshua Tseng
- Cedars Sinai Medical Center, Los Angeles, California
| | | | | | | | | | - Patricia Hain
- Cedars Sinai Medical Center, Los Angeles, California
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15
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Zhang J, Li Y, Peng Z. Prognostic Factors and Efficacy for Continuous Renal Replacement Therapy in Critically Ill Patients: A Chinese Single-Center Retrospective Study. Blood Purif 2017; 45:53-60. [PMID: 29216644 DOI: 10.1159/000481769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/23/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is controversy about the efficacy and prognostic factors for continuous renal replacement therapy (CRRT) in China due to practice variation. Our aim is to investigate these questions. METHOD A total of 613 adult patients receiving CRRT in last 3 years from one Chinese ICU were enrolled. The analysis of demographic data, vital signs, and laboratory tests prior to CRRT and outcomes were performed. The data between pre- and post-CRRT were compared for efficacy analysis. RESULTS Prior to CRRT, partial pressure of carbon dioxide (PCO2), systolic blood pressure (SBP), gender, age, bilirubin, cystatin C, and mechanical ventilation were correlated with in-hospital mortality. In a binary logistic regression, PCO2, SBP, age, and gender were significant in predicting mortality. Cox regression analysis demonstrated PCO2 independent association with mortality, and lower SBP worse mortality. CRRT could eliminate the fluid and metabolites. CONCLUSION CO2 retention and low SBP prior to CRRT were associated with increased mortality. CRRT significantly improved hemeostasis.
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16
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Schell-Chaple H. Continuous Renal Replacement Therapies: Raising the Bar for Quality Care. AACN Adv Crit Care 2017; 28:28-40. [PMID: 28254853 DOI: 10.4037/aacnacc2017235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Hildy Schell-Chaple
- Hildy Schell-Chaple is Clinical Nurse Specialist, University of California, San Francisco Medical Center, 505 Parnassus Ave, San Francisco, CA 94143
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17
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Schell-Chaple H. Continuous Renal Replacement Therapy Update: An Emphasis on Safe and High-Quality Care. AACN Adv Crit Care 2017; 28:31-40. [PMID: 28254854 DOI: 10.4037/aacnacc2017816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Continuous renal replacement therapy (CRRT) was introduced more than 40 years ago as a renal support option for critically ill patients who had contraindications to intermittent hemodialysis and peritoneal dialysis. Despite being the most common renal support therapy used in intensive care units today, the tremendous variability in CRRT management challenges the interpretation of findings from CRRT outcome studies. The lack of standardization in practice and training of clinicians along with the high risk of CRRT-related adverse events has been the impetus for the recent expert consensus work on identifying quality indicators for CRRT programs. This article summarizes the potential complications that establish CRRT as a high-risk therapy and also the recently published best-practice recommendations for providing high-quality CRRT.
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Affiliation(s)
- Hildy Schell-Chaple
- Hildy Schell-Chaple is Clinical Nurse Specialist, University of California, San Francisco Medical Center, 505 Parnassus Ave, San Francisco, CA 94143
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18
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Marenzi G, Cosentino N, Marinetti A, Leone AM, Milazzo V, Rubino M, De Metrio M, Cabiati A, Campodonico J, Moltrasio M, Bertoli S, Cecere M, Mosca S, Marana I, Grazi M, Lauri G, Bonomi A, Veglia F, Bartorelli AL. Renal replacement therapy in patients with acute myocardial infarction: Rate of use, clinical predictors and relationship with in-hospital mortality. Int J Cardiol 2017; 230:255-261. [DOI: 10.1016/j.ijcard.2016.12.130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 11/21/2016] [Accepted: 12/16/2016] [Indexed: 11/25/2022]
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Iwagami M, Yasunaga H, Noiri E, Horiguchi H, Fushimi K, Matsubara T, Yahagi N, Nangaku M, Doi K. Potential Survival Benefit of Polymyxin B Hemoperfusion in Septic Shock Patients on Continuous Renal Replacement Therapy: A Propensity-Matched Analysis. Blood Purif 2016; 42:9-17. [PMID: 26918904 DOI: 10.1159/000444474] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/05/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS We assessed the survival benefit of polymyxin B hemoperfusion (PMX) in septic shock patients starting continuous renal replacement therapy (CRRT), who are known to have an increased rate of mortality. METHODS Adult patients in the Japanese diagnosis procedure combination database satisfying the following criteria were enrolled: hospitalized in 2007-2012; diagnosed as having sepsis; required noradrenaline and/or dopamine; and started CRRT in intensive care unit. Propensity scores for receiving PMX were created from patient and hospital characteristics. RESULTS Of 3,759 eligible patients, 1,068 received PMX. Propensity-score matching produced a matched cohort of 978 pairs. The 28-day mortality was 40.2% (393/978) in the PMX group and 46.8% (458/978) in the control group (p = 0.003). Logistic regression analysis revealed a significant association between the use of PMX and decreased 28-day mortality (adjusted OR 0.75; 95% CI 0.62-0.91). CONCLUSION This large retrospective study suggests that septic shock patients starting CRRT may benefit from PMX.
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Affiliation(s)
- Masao Iwagami
- Department of Hemodialysis and Apheresis, School of Public Health, The University of Tokyo Hospital, Tokyo, Japan
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