TY - JOUR
T1 - Predictors of withdrawal from renal replacement therapy among patients with acute kidney injury requiring renal replacement therapy
AU - Ihara, Katsuhito
AU - Ishigami, Junichi
AU - Inoshita, Seiji
N1 - Publisher Copyright:
© 2019, Japanese Society of Nephrology.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Background: Although recovery of renal function after an episode of acute kidney injury (AKI) is an important clinical measure of morbidity, predictors of withdrawal from renal replacement therapy (RRT) among AKI patients remain unclear. Methods: In this single-center retrospective cohort study, we examined the clinical records of AKI patients requiring RRT who were hospitalized in the ICU or general wards at our hospital from January 2010 to December 2013. A priori-determined covariates of age, sex, cardiovascular disease, chronic kidney disease (CKD), mean arterial pressure (MAP), sepsis, nephrotoxic agents, and hypoalbuminemia were assessed in Cox hazard models to estimate hazard ratio (HR). Results: A total of 334 patients were enrolled (median age, 68 years; interquartile range [IQR], 57–77 years; male, 71.6%). During follow-up 157 (47.0%) patients achieved RRT withdrawal. Multivariable Cox regression analysis revealed that CKD, MAP between 95 and 105 mmHg and MAP ≥ 105 mmHg, compared with MAP between 65 and 75 mmHg, ventilator use and hypoalbuminemia, were significantly associated with RRT withdrawal. Conclusion: Among patients with AKI requiring RRT, CKD, ventilator use, hypoalbuminemia, and high MAP were associated with RRT withdrawal. Furthermore, keeping a higher MAP at RRT initiation can potentially lead to dependence on RRT.
AB - Background: Although recovery of renal function after an episode of acute kidney injury (AKI) is an important clinical measure of morbidity, predictors of withdrawal from renal replacement therapy (RRT) among AKI patients remain unclear. Methods: In this single-center retrospective cohort study, we examined the clinical records of AKI patients requiring RRT who were hospitalized in the ICU or general wards at our hospital from January 2010 to December 2013. A priori-determined covariates of age, sex, cardiovascular disease, chronic kidney disease (CKD), mean arterial pressure (MAP), sepsis, nephrotoxic agents, and hypoalbuminemia were assessed in Cox hazard models to estimate hazard ratio (HR). Results: A total of 334 patients were enrolled (median age, 68 years; interquartile range [IQR], 57–77 years; male, 71.6%). During follow-up 157 (47.0%) patients achieved RRT withdrawal. Multivariable Cox regression analysis revealed that CKD, MAP between 95 and 105 mmHg and MAP ≥ 105 mmHg, compared with MAP between 65 and 75 mmHg, ventilator use and hypoalbuminemia, were significantly associated with RRT withdrawal. Conclusion: Among patients with AKI requiring RRT, CKD, ventilator use, hypoalbuminemia, and high MAP were associated with RRT withdrawal. Furthermore, keeping a higher MAP at RRT initiation can potentially lead to dependence on RRT.
KW - AKI requiring RRT
KW - Acute kidney injury (AKI)
KW - Discontinuation
KW - Predictors
KW - Renal replacement therapy (RRT)
KW - Withdrawal
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U2 - 10.1007/s10157-019-01711-y
DO - 10.1007/s10157-019-01711-y
M3 - Article
C2 - 30778780
AN - SCOPUS:85061746146
SN - 1342-1751
VL - 23
SP - 814
EP - 824
JO - Clinical and Experimental Nephrology
JF - Clinical and Experimental Nephrology
IS - 6
ER -