(404) Retrospective Descriptive Study of Continuous Renal Replacement Therapy (CRRT) Utilization in ICU

Introduction: Acute kidney injury (AKI) in critically ill patients is associated with increased mortality. Some experts recommend CRRT for renal replacement therapy, especially in hemodynamically unstable patients. Despite its widespread use, detailed information on its application and clinical outcomes across different contexts is lacking. Our descriptive study aims to fill this gap by analyzing CRRT utilization in critically ill patients and identifying factors associated with mortality.

Methods: This retrospective single-center study examined CRRT utilization, patient characteristics, and outcomes over one year. Data were extracted from the electronic medical records of patients who underwent CRRT in the Rutgers Health/Community Medical Center ICUs from January 1st, 2023, to December 31st, 2023. Variables included patient demographics, comorbidities, APACHE II scores, CRRT indications, duration of therapy, and clinical outcomes at discharge. Statistical analyses included Mann-Whitney and chi-square tests.

Results: The dataset comprised 50 patients, averaging 66.08 years old, 62% male, and a mean BMI of 31.05 kg/m². Common indications for CRRT initiation included severe AKI, with 52% electrolyte disturbances, 18% volume overload, and 10% cardiac arrest. The mean APACHE II score at CRRT initiation was 29.52, predicting non-operative mortality of 62.76%, but it was not statistically associated with mortality. CRRT duration averaged 3.94 days, with a mean ICU stay of 8.02. In-hospital mortality was 66%. Higher mortality was noted in patients receiving vasopressor treatment (93.9%, 31/33) compared to those who did not. Older age was statistically associated with mortality. Patients with AKI had a higher mortality (73%) compared to those requiring CRRT with end-stage renal disease (17%). Non-recovery of AKI was associated with a higher mortality rate.

Conclusions: In our data set, critically ill patients undergoing CRRT had an overall mortality of 66%. This increased to 73% in patients with new AKI. Patients with previous ESRD had a mortality rate of 17%. Notably, mortality among patients undergoing CRRT and requiring vasopressors was 93.9%. Factors associated with increased mortality included older age, need for vasopressors, new renal failure, and non-recovery of renal function.