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Titolo Delivered dose of renal replacement therapy and mortality in critically ill patients with acute kidney injury
Autore Sergio Vesconi*1, Dinna Cruz*2, Roberto Fumagalli3, Detlef Kindgen-Milles4, Gianpaola Monti1, Anibal Marinho5, Filippo Mariano6 , Marco Formica7, Mariano Marchesi8 , Robert René9, Sergio Livigni10, Claudio Ronco 2 for the DOse REsponse Multicentre International collaborative Initiative (DO-RE-MI Study Group) - From the 1 Department of Anesthesiology and Intensive Care, Hospital Niguarda, Piazza dell´Ospedale Maggiore 3, 20162, Milan, Italy; 2 Department of Nephrology, Dialysis and Transplantation, St Bortolo Hospital, Viale Rodolfi 37, 36100 Vicenza, Italy; 3 Department of Anaesthesiology and Intensive Care I, St Gerardo dei Tintori Hospital, Via Giovanni Pergolesi 33, 20100 Monza, Italy; 4 Anesthesiology Clinic, University of Düsseldorf, Moorenstr. 5, 40225 Germany; 5 Hospital Center of Porto, Alameda do Prof. Hernâni Monteiro, 4200 Paranhos, Porto, Portugal; 6 Nephrology and Dialysis Unit, CTO Hospital, Via Gianfranco Zuretti 29, 10126 Turin, Italy; 7 Department of Nephrology, Hospital Santa Croce e Carle, Via Michele Coppino 26, 12100 Cuneo, Italy; 8 Department of Anaesthesiology and Intensive Care, Riuniti di Bergamo Hospital, Via Tito Livio 2, 24123 Bergamo, Italy; 9 Intensive Care Unit, University of Poitiers, 2, rue de la Miletrie, 86021, Poitiers, France; 10 Department of Intensive Care, Giovanni Bosco Hospital, Piazza Del Donatore di Sangue 3, 10154 Torino, Italy.
Referenza Critical Care 2009; 13: R57 doi: 10.1186/cc7784
Contenuto Background: Optimal dialysis dose for the treatment of acute kidney injury (AKI) is controversial. We sought to evaluate the relationship between renal replacement therapy (RRT) dose and outcome. Methods: We performed a prospective multicenter observational study in 30 intensive care units (ICUs) in 8 countries from June 2005 to December 2007. Delivered RRT dose was calculated in patients treated exclusively with either continuous (CRRT) or intermittent RRT (IRRT) during their ICU stay. Dose was categorized into more-intensive (CRRT ≥ 35ml/kg/hr, IRRT ≥ 6sessions/week) or less-intensive (CRRT < 35ml/kg/hr, IRRT < 6sessions/week). The main outcome measures were ICU mortality, ICU length of stay, and duration of mechanical ventilation. Results: Of 15,200 critically ill patients admitted during the study period, 553 AKI patients were treated with RRT, including 338 who received CRRT only and 87 IRRT only. For CRRT, the median delivered dose was 27.1(IQR 22.1,33.9) ml/kg/hr. For IRRT, the median dose was 7(IQR 5,7) sessions/week. Only 22% of CRRT patients and 64% of IRRT patients received a more-intensive dose. Crude ICU mortality among CRRT patients were 60.8% vs. 52.5% (more- vs. less-intensive groups, respectively). In IRRT, this was 23.6 vs. 19.4%, respectively. On multivariable analysis, there was no significant association between RRT dose and ICU mortality (Odds Ratio [OR] more- vs. less-intensive: CRRT 1.21, 95%CI 0.66 to 2.21; IRRT 1.50, 95%CI 0.48 to 4.67). Among survivors, shorter ICU stay and duration of mechanical ventilation were observed in the more-intensive RRT groups [more- vs. less-intensive for all: CRRT 15 (IQR 8,26) vs. 19.5 (IQR 12,33.5) ICU days, P = 0.063; 7 (IQR 4,17) vs. 14 (IQR 5,24) ventilation days, P = 0.031; IRRT 8 (IQR 5.5,14) vs. 18 (IQR 13,35) ICU days, P = 0.008; 2.5 (IQR 0,10) vs. 12 (IQR 3,24) ventilation days], P = 0.026. Conclusions: After adjustment for multiple variables, these data provide no evidence for a survival benefit afforded by higher dose RRT. However, more-intensive RRT was associated with a favourable effect on ICU stay and duration of mechanical ventilation among survivors. This deserves further exploration. Trial Registration: Cochrane Renal Group (CRG110600093)
Data 23.04.2009
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