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Article: Impact of renal replacement therapy on survival in patients with KDIGO Stage 3 acute kidney injury: A propensity score matched analysis

TitleImpact of renal replacement therapy on survival in patients with KDIGO Stage 3 acute kidney injury: A propensity score matched analysis
Authors
Keywordsacute renal failure
clinical nephrology
continuous renal replacement therapy
haemodialysis
Issue Date2018
PublisherWiley-Blackwell Publishing Asia. The Journal's web site is located at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1440-1797
Citation
Nephrology, 2018, v. 25 n. 12, p. 1081-1089 How to Cite?
AbstractAim To investigate the impact of renal replacement therapy (RRT) on 90‐day mortality in critically ill patients suffering from KDIGO stage 3 acute kidney injury (AKI) with or without life‐threatening complications using propensity score matching analysis. Methods We conducted a retrospective analysis of critically ill adult patients with KDIGO Stage 3 AKI with or without RRT during ICU stay between 1/1/2011‐31/12/2013. Cox regression analysis and propensity score matching methods were used to determine predictors for 90‐day mortality. Results Among 661 patients, 50.5% received RRT. The unadjusted 90‐day mortality rate was 42.5% and 54.1% in patients who had or had not received RRT, respectively. After adjustment with propensity score based on the probability of receiving RRT, the cox regression analysis showed that RRT was associated with a lower 90‐day mortality (p<0.001). Among 322 propensity‐matched pairs, RRT was associated with lower ICU (23.6% vs. 39.8%, p=0.002), hospital (33.5% vs. 55.9%, p<0.001) and 90‐day mortality (34.2% vs. 58.4%, p<0.001), and a higher 90‐day renal recovery rate (57.8% vs. 45.3% full recovery, p=0.026) compared with no RRT. When an alternate propensity model was used, the benefits associated with RRT were very similar, except 90‐day renal recovery became insignificant. Conclusion Our observational study found that in critically ill patients with KDIGO Stage 3 AKI, RRT may be associated with lower 90‐day mortality. The benefit of RRT on renal recovery was less prominent. Medical futility and practice variations may complicate study interpretation. To avoid these limitations, large‐scale multicenter, non‐observational study is recommended.
Persistent Identifierhttp://hdl.handle.net/10722/247510
ISSN
2017 Impact Factor: 2.178
2015 SCImago Journal Rankings: 0.894
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorShum, HP-
dc.contributor.authorChan, KC-
dc.contributor.authorTam, CW-
dc.contributor.authorYan, WW-
dc.contributor.authorChan, DTM-
dc.date.accessioned2017-10-18T08:28:24Z-
dc.date.available2017-10-18T08:28:24Z-
dc.date.issued2018-
dc.identifier.citationNephrology, 2018, v. 25 n. 12, p. 1081-1089-
dc.identifier.issn1320-5358-
dc.identifier.urihttp://hdl.handle.net/10722/247510-
dc.description.abstractAim To investigate the impact of renal replacement therapy (RRT) on 90‐day mortality in critically ill patients suffering from KDIGO stage 3 acute kidney injury (AKI) with or without life‐threatening complications using propensity score matching analysis. Methods We conducted a retrospective analysis of critically ill adult patients with KDIGO Stage 3 AKI with or without RRT during ICU stay between 1/1/2011‐31/12/2013. Cox regression analysis and propensity score matching methods were used to determine predictors for 90‐day mortality. Results Among 661 patients, 50.5% received RRT. The unadjusted 90‐day mortality rate was 42.5% and 54.1% in patients who had or had not received RRT, respectively. After adjustment with propensity score based on the probability of receiving RRT, the cox regression analysis showed that RRT was associated with a lower 90‐day mortality (p<0.001). Among 322 propensity‐matched pairs, RRT was associated with lower ICU (23.6% vs. 39.8%, p=0.002), hospital (33.5% vs. 55.9%, p<0.001) and 90‐day mortality (34.2% vs. 58.4%, p<0.001), and a higher 90‐day renal recovery rate (57.8% vs. 45.3% full recovery, p=0.026) compared with no RRT. When an alternate propensity model was used, the benefits associated with RRT were very similar, except 90‐day renal recovery became insignificant. Conclusion Our observational study found that in critically ill patients with KDIGO Stage 3 AKI, RRT may be associated with lower 90‐day mortality. The benefit of RRT on renal recovery was less prominent. Medical futility and practice variations may complicate study interpretation. To avoid these limitations, large‐scale multicenter, non‐observational study is recommended.-
dc.languageeng-
dc.publisherWiley-Blackwell Publishing Asia. The Journal's web site is located at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1440-1797-
dc.relation.ispartofNephrology-
dc.rightsPreprint This is the pre-peer reviewed version of the following article: [FULL CITE], which has been published in final form at [Link to final article]. Authors are not required to remove preprints posted prior to acceptance of the submitted version. Postprint This is the accepted version of the following article: [full citation], which has been published in final form at [Link to final article].-
dc.subjectacute renal failure-
dc.subjectclinical nephrology-
dc.subjectcontinuous renal replacement therapy-
dc.subjecthaemodialysis-
dc.titleImpact of renal replacement therapy on survival in patients with KDIGO Stage 3 acute kidney injury: A propensity score matched analysis-
dc.typeArticle-
dc.identifier.emailChan, DTM: dtmchan@hkucc.hku.hk-
dc.identifier.authorityChan, DTM=rp00394-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1111/nep.13164-
dc.identifier.pmid28898482-
dc.identifier.scopuseid_2-s2.0-85057478373-
dc.identifier.hkuros280388-
dc.identifier.volume25-
dc.identifier.issue12-
dc.identifier.spage1081-
dc.identifier.epage1089-
dc.identifier.isiWOS:000451461200002-
dc.publisher.placeAustralia-

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