Background: Continuous kidney replacement therapy (CKRT) is a crucial intervention for hemodynamically unstable patients with acute kidney injury (AKI). Despite the recommendations to offer a CKRT dose of 20-25 mL/kg/h, the optimal CKRT dose remains uncertain, especially whether low-dose CKRT is associated with poor outcomes. This study investigated the association between low CKRT dosage and 90-day mortality using a marginal structural model (MSM).
Methods: Using the MIMIC-IV database, adult patients who received CKRT for more than 24 hours were included. Data on time-fixed and time-dependent variables were collected. Patients were categorized based on CKRT dose thresholds of 13 and 20 ml/kg/h.
Results: Among the 1,329 patients, the 90-day mortality rate was 49.6%. The median age of the patients was 62 years (IQR: 52-72). Changes in CKRT dosing during treatment were frequent. Patients with a reduced delivered CKRT dose (<20 and < 13 ml/kg/h) generally exhibited low values during the initial days of CKRT, with an increase in the delivered CKRT dose. After adjusting only for baseline variables (traditional Cox regression model), patients receiving CKRT doses <13 ml/kg/h had significantly greater 90-day mortality (HR: 1.70, 95% CI 1.16-2.49) than those receiving CKRT doses ≥13 ml/kg/h. However, after adjusting for time-dependent variables, the CKRT dose was not significantly associated with mortality at either the 13 or 20 ml/kg/h threshold. Additionally, there were no significant associations between the delivered CKRT dose and 90-day mortality within the range of 5 to 40 ml/kg/h.
Conclusion: This study highlights the impact of methodological approaches on the association between CKRT dose and mortality and that with personalized adjustments, there may not be a lower limit of the unsafe CKRT dose. However, lower CKRT doses were initially associated with higher mortality, and adjusting for time-dependent variables nullified this association.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/SHK.0000000000002435 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Use of vasopressors in patients with acute kidney injury on continuous kidney replacement therapy.
PLoS One
December 2024
Division of Nephrology, Department of Medicine, West Virginia University, Morgantown, West Virginia, United States of America.
Objective: To investigate whether the use of a specific vasopressor was associated with increased mortality or adverse outcomes in patients with acute kidney injury (AKI) receiving continuous kidney replacement therapy (CKRT).
Methods: Patients with AKI who underwent CKRT between 1/1/2012-1/1/2021 at a tertiary academic hospital were included. Cox proportional hazard model was used to assess the relationship between time-dependent vasopressor dose and in-hospital mortality.
Intensive care unit continuous kidney replacement therapy: time to change dosage recommendations?
Int Urol Nephrol
October 2024
Department of Internal Medicine IV, University Hospital Munich, Ziemssenstr.3, D 80336, Munich, Germany.
Article Synopsis
- Continuous kidney replacement therapy (CKRT) is crucial for unstable adult ICU patients with severe acute kidney injury (AKI), and its success relies on achieving proper dosing according to KDIGO guidelines.
- Current practices vary globally, with evidence suggesting that lower CKRT doses (under 20 ml/kg/h) may lead to higher mortality and that the optimal minimal effective dose remains unknown, creating a need for further research.
- In Japan, the median delivered CKRT dose for severe AKI patients is often below recommended levels, raising questions about treatment adequacy and the need for individualized dosing in critical care settings.
Monte Carlo simulations of cefepime in children receiving continuous kidney replacement therapy support continuous infusions for target attainment.
J Intensive Care
October 2024
Division of Translational and Clinical Pharmacology, CCHMC, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
Article Synopsis
- Sepsis can lead to acute kidney injury, requiring continuous kidney replacement therapy (CKRT), and this therapy can impact how drugs like cefepime are processed in critically ill children.
- Researchers conducted Monte Carlo simulations (MCS) to evaluate different dosing strategies of cefepime for children on CKRT, focusing on achieving desired drug concentrations against bacteria like Pseudomonas aeruginosa.
- They found that continuous infusions of cefepime resulted in a higher probability of reaching effective drug levels compared to other dosing methods, especially at higher doses and lower residual kidney function.
Background: Continuous kidney replacement therapy (CKRT) is a crucial intervention for hemodynamically unstable patients with acute kidney injury (AKI). Despite the recommendations to offer a CKRT dose of 20-25 mL/kg/h, the optimal CKRT dose remains uncertain, especially whether low-dose CKRT is associated with poor outcomes. This study investigated the association between low CKRT dosage and 90-day mortality using a marginal structural model (MSM).
View Article and Find Full Text PDFImpact of specialized renal technologists on optimizing delivery of continuous kidney replacement therapy in critical care areas a retrospective study.
Hemodial Int
July 2024
Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, UAE.
Background: Continuous renal replacement therapy (CKRT) is delivered to some of the most critically ill patients in hospitals. This therapy is expensive and requires coordination of multidisciplinary teams to ensure the prescribed dose is delivered. With increased demands on the critical care nursing staff and increased complexities of patients admitted to critical care units, we evaluated the role of specialized renal technologists in ensuring the prescribed dose is delivered.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!