Introduction: Acute kidney injury is common in 7 percent of admissions to the hospital and 30 percent of admissions to the ICU. Mortality is significant, and AKI is often associated with other major comorbidities including diabetes, sepsis and heart failure. The present study looked at the frequency of AKI co-morbidities in patients receiving acute kidney replacement therapy, and the outcomes of those patients receiving therapy either with Intermittent Hemodialysis (IHD) or Continuous Kidney Replacement Therapy (CKRT).
Methods: Our study is a comparative retrospective cohort assessment, using the TrinetX platform, of ICU patients suffering from AKI and undergoing IHD versus CKRT. The clinical outcomes studied in both groups encompassed ICU admission, mechanical ventilation/intubation, and all-cause mortality at 30, 90, 180 and 365-day follow-up post-treatment.
Results: There were 23443 adults with AKI on renal replacement therapy studied in the ICU [IHD cohort (n=6993); CKRT cohort (n=16450)]. A greater percentage of IHD patients had diabetes, hypertensive diseases, and renal tubulo-interstitial disease. However, more CKRT patients had liver diseases. No significant difference was seen in chronic lower respiratory diseases or osteoarthritis.
For all-cause mortality and ICU admissions, the IHD cohort had lower rates than the CKRT cohort. While for ventilation/intubation rates, IHD cohort was higher. The relative effect on mortality was a 30 percent decrease in risk ratio from day 30 to 365. For ICU admissions, a 26 percent decrease within a similar time frame. For ventilation/intubation rates, the results were a 16 percent increase at day 30 and a 17 percent increase at day 365.
Conclusions: Using the data gathered, it was found that ICU patients (AKI) treated with CKRT showed a higher risk of ICU readmission and risk of mortality compared to those treated with IHD. Further, the IHD patients had a higher incidence of ventilation/intubation at every time-point. The understanding of the underlying mechanisms leading to the aforementioned differences remains either unknown to date, or only partly understood. Clearly, more in-depth research endeavors are necessary for further advancement, in order to develop appropriate intervention strategies for the two dialysis methods.
