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Ziegler J, Morley K, Pilcher D, Bellomo R, Soares M, Salluh JIF, Borges LP, Bagshaw SM, Hudson D, Christiansen CF, Heide-Jorgensen U, Lone NI, Buyx A, McLennan S, Celi LA, Rush B. Epidemiology of Renal Replacement Therapy for Critically Ill Patients across Seven Health Jurisdictions. Am J Nephrol 2024:1-12. [PMID: 38889694 DOI: 10.1159/000539811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/08/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Acute kidney injury (AKI) requiring treatment with renal replacement therapy (RRT) is a common complication after admission to an intensive care unit (ICU) and is associated with significant morbidity and mortality. However, the prevalence of RRT use and the associated outcomes in critically patients across the globe are not well described. Therefore, we describe the epidemiology and outcomes of patients receiving RRT for AKI in ICUs across several large health system jurisdictions. METHODS Retrospective cohort analysis using nationally representative and comparable databases from seven health jurisdictions in Australia, Brazil, Canada, Denmark, New Zealand, Scotland, and the USA between 2006 and 2023, depending on data availability of each dataset. Patients with a history of end-stage kidney disease receiving chronic RRT and patients with a history of renal transplant were excluded. RESULTS A total of 4,104,480 patients in the ICU cohort and 3,520,516 patients in the mechanical ventilation cohort were included. Overall, 156,403 (3.8%) patients in the ICU cohort and 240,824 (6.8%) patients in the mechanical ventilation cohort were treated with RRT for AKI. In the ICU cohort, the proportion of patients treated with RRT was lowest in Australia and Brazil (3.3%) and highest in Scotland (9.2%). The in-hospital mortality for critically ill patients treated with RRT was almost fourfold higher (57.1%) than those not receiving RRT (16.8%). The mortality of patients treated with RRT varied across the health jurisdictions from 37 to 65%. CONCLUSION The outcomes of patients who receive RRT in ICUs throughout the world vary widely. Our research suggests that differences in access to and provision of this therapy are contributing factors.
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Affiliation(s)
- Jennifer Ziegler
- Department of Internal Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,
| | - Katharine Morley
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - David Pilcher
- ANZICS Centre for Outcome and Resource Evaluation, Prahran, Victoria, Australia
- Department of Intensive Care, The Alfred Hospital, Prahran, Victoria, Australia
- The Australian and New Zealand Intensive Care - Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- The Australian and New Zealand Intensive Care - Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
| | - Marcio Soares
- D'OR Institute for Research and Education, Rio de Janeiro, Brazil
- Post Graduation Program in Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Research and Development, Epimed Solutions, Rio de Janeiro, Brazil
| | - Jorge I F Salluh
- D'OR Institute for Research and Education, Rio de Janeiro, Brazil
- Post Graduation Program in Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lunna P Borges
- Department of Research and Development, Epimed Solutions, Rio de Janeiro, Brazil
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Darren Hudson
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
- eCritical Alberta, Alberta Health Services, Edmonton, Alberta, Canada
| | - Christian F Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Uffe Heide-Jorgensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Nazir I Lone
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Alena Buyx
- Institute of History and Ethics in Medicine, Department of Preclinical Medicine, TUM School of Medicine and Health, Technical Univeristy of Munich, Munich, Germany
| | - Stuart McLennan
- Institute of History and Ethics in Medicine, Department of Preclinical Medicine, TUM School of Medicine and Health, Technical Univeristy of Munich, Munich, Germany
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Leo A Celi
- Harvard Medical School, Boston, Massachusetts, USA
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Barret Rush
- Department of Internal Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Abstract
PURPOSE OF REVIEW The population is aging, and recent epidemiologic work reveals that an increasing number of older adults are presenting to the ICU with preexisting geriatric syndromes. In this update, we discuss recent literature pertaining to the long-term recovery of older ICU patients and highlight gaps in current knowledge. RECENT FINDINGS A recent longitudinal study demonstrated that the incidence of frailty, disability, and multimorbidity among older ICU patients is rising; these geriatric syndromes have all previously been shown to impact long-term recovery. Recent studies have demonstrated the impact of social factors in long-term outcomes after critical illness; for example, social isolation was recently shown to be associated with disability and mortality among older adults in the year after critical illness. Socioeconomic disadvantage is associated with higher rates of dementia and disability following critical illness impacting recovery, and further studies are necessary to better understand factors influencing this disparity. The COVID-19 pandemic disproportionately impacted older adults, resulting in worse outcomes and increased rates of functional decline and social isolation. In considering how to best facilitate recovery for older ICU survivors, transitional care programs may address the unique needs of older adults and help them adapt to new disability if recovery has not been achieved. SUMMARY Recent work demonstrates increasing trends of geriatric syndromes in the ICU, all of which are known to confer increased vulnerability among critically ill older adults and decrease the likelihood of post-ICU recovery. Risk factors are now known to extend beyond geriatric syndromes and include social risk factors and structural inequity. Strategies to improve post-ICU recovery must be viewed with a lens across the continuum of care, with post-ICU recovery programs targeted to the unique needs of older adults.
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Affiliation(s)
| | - Lauren E Ferrante
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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