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Choice of renal replacement therapy modality in intensive care units: data from a Japanese Nationwide Administrative Claim Database.

Abstract：

PURPOSE:This study was undertaken to assess recent trends of the choice of renal replacement therapy (RRT) modalities in Japanese intensive care units (ICUs). MATERIALS AND METHODS:Data were extracted from the Japanese Diagnosis Procedure Combination database for 2011. We identified adult patients without end-stage renal disease who had been admitted to ICUs for 3 days or longer and started continuous RRT (CRRT) or intermittent RRT (IRRT). Logistic regression was used to analyze which factors affected the modality choice. We further evaluated in-hospital mortality according to the choice of RRT. RESULTS:Of 7353 eligible patients, 5854 (79.6%) initially received CRRT. The choice of CRRT was independently associated with sex (female), diagnosis of sepsis, hospital type (academic) and volume, vasoactive agents, mechanical ventilation, colloid administration, blood transfusion, intra-aortic balloon pumping, and venoarterial extracorporeal membrane oxygenation. Particularly, the number of vasoactive drugs was strongly associated with the CRRT choice. Overall in-hospital mortality in the CRRT group was higher than that in the IRRT group (50.0% vs 31.1%) and was increased when IRRT was switched to CRRT (59.1%). CONCLUSIONS:Continuous RRT is apparently preferred in actual ICU practice, especially for hemodynamically unstable patients, and subsequent RRT modality switch is associated with mortality.

journal_name

J Crit Care

journal_title

Journal of critical care

authors

Iwagami M,Yasunaga H,Noiri E,Horiguchi H,Fushimi K,Matsubara T,Yahagi N,Nangaku M,Doi K

doi

10.1016/j.jcrc.2014.11.003

subject

Has Abstract

pub_date

2015-04-01 00:00:00

pages

381-5

issue

2

eissn

0883-9441

issn

1557-8615

pii

S0883-9441(14)00456-0

journal_volume

30

pub_type

杂志文章

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