Incidence, underlying conditions, and outcomes of patients receiving acute renal replacement therapies in tertiary cardiac intensive care units: An analysis from the Critical Care Cardiology Trials Network Registry.Citation: American Heart Journal. 222:8-14, 2020 04.PMID: 32006910Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Acute Kidney Injury/ep [Epidemiology] | *Cardiovascular Diseases/co [Complications] | *Coronary Care Units/sn [Statistics & Numerical Data] | *Critical Care/mt [Methods] | *Registries | *Renal Replacement Therapy/mt [Methods] | Acute Kidney Injury/co [Complications] | Acute Kidney Injury/th [Therapy] | Aged | Canada/ep [Epidemiology] | Cardiovascular Diseases/ep [Epidemiology] | Cross-Sectional Studies | Female | Follow-Up Studies | Humans | Incidence | Male | Middle Aged | Risk Factors | Survival Rate/td [Trends] | United States/ep [Epidemiology]Year: 2020Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
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Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
BACKGROUND: The prevalence of renal disease in cardiac intensive care units (CICUs) is increasing, but little is known about the utilization, concurrent therapies, and outcomes of patients requiring acute renal replacement therapy (RRT) in this specialized environment.
CONCLUSIONS: These data underscore the risks associated with the provision of renal support in patients with primary cardiovascular problems and the need to develop standardized indications and potential futility measures in this specialized population. Copyright (c) 2020 Elsevier Inc. All rights reserved.
METHODS: In the Critical Care Cardiology Trials Network, 16 centers submitted data on CICU admissions including acute RRT (defined as continuous renal replacement therapy and/or acute intermittent dialysis).
RESULTS: Among 2,985 admissions, 178 (6.0%; interhospital range 1.0%-16.0%) received acute RRT. Patients receiving RRT, versus not, were more commonly admitted for cardiogenic shock (15.7% vs 4.2%, P<.01), cardiac arrest (9.6% vs 3.7%, P<.01), and acute general medical diagnoses (10.7% vs 5.8%, P<.01), whereas acute coronary syndromes (16.9% vs 32.1%, P<.01) were less frequent. Variables independently associated with acute RRT included diabetes, heart failure, liver disease, severe valvular disease, shock, cardiac arrest, hypertension, and younger age. In patients receiving acute RRT, versus not, advanced therapies including mechanical ventilation (55.6% vs 18.0%), vasoactive support (73.0% vs 35.2%), invasive hemodynamic monitoring (59.6% vs 29.2%), and mechanical circulatory support (27.5% vs 8.4%) were more common. Acute RRT was associated with higher in-hospital mortality (42.1% vs 9.3%, adjusted odds ratio 3.74, 95% CI, 2.52-5.53) and longer median length of stay (10.0 vs 5.3days, P<.01). In conclusion, acute RRT in contemporary CICUs was associated with the provision of other advanced therapies and lower survival.