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Renal Replacement Therapy Modality in the ICU and Renal Recovery at Hospital Discharge*

Bonnassieux, Martin, MD1,2; Duclos, Antoine, MD, PhD3; Schneider, Antoine G., MD, PhD4; Schmidt, Aurélie, MS5; Bénard, Stève, PharmD5; Cancalon, Charlotte, MS5; Joannes-Boyau, Olivier, MD6; Ichai, Carole, MD, PhD7,8; Constantin, Jean-Michel, MD, PhD9; Lefrant, Jean-Yves, MD, PhD10; Kellum, John A., MD, FACP, MCCM11; Rimmelé, Thomas, MD, PhD1,2 for the AzuRéa Group

doi: 10.1097/CCM.0000000000002796
Online Clinical Investigations

Objectives: Acute kidney injury requiring renal replacement therapy is a major concern in ICUs. Initial renal replacement therapy modality, continuous renal replacement therapy or intermittent hemodialysis, may impact renal recovery. The aim of this study was to assess the influence of initial renal replacement therapy modality on renal recovery at hospital discharge.

Design: Retrospective cohort study of all ICU stays from January 1, 2010, to December 31, 2013, with a “renal replacement therapy for acute kidney injury” code using the French hospital discharge database.

Setting: Two hundred ninety-one ICUs in France.

Patients: A total of 1,031,120 stays: 58,635 with renal replacement therapy for acute kidney injury and 25,750 included in the main analysis.

Interventions: None.

Measurements Main Results: PPatients alive at hospital discharge were grouped according to initial modality (continuous renal replacement therapy or intermittent hemodialysis) and included in the main analysis to identify predictors of renal recovery. Renal recovery was defined as greater than 3 days without renal replacement therapy before hospital discharge. The main analysis was a hierarchical logistic regression analysis including patient demographics, comorbidities, and severity variables, as well as center characteristics. Three sensitivity analyses were performed. Overall mortality was 56.1%, and overall renal recovery was 86.2%. Intermittent hemodialysis was associated with a lower likelihood of recovery at hospital discharge; odds ratio, 0.910 (95% CI, 0.834–0.992) p value equals to 0.0327. Results were consistent across all sensitivity analyses with odds/hazards ratios ranging from 0.883 to 0.958.

Conclusions: In this large retrospective study, intermittent hemodialysis as an initial modality was associated with lower renal recovery at hospital discharge among patients with acute kidney injury, although the difference seems somewhat clinically limited.

1Department of Anesthesiology and Critical Care Medicine, Edouard Herriot hospital, Lyon, France.

2EA 7426 (Université Claude Bernard Lyon 1 – Hospices Civils de Lyon – bioMérieux) “Pathophysiology of Injury-induced Immunosupression – PI3,” Joint Research Unit, Edouard Herriot Hospital, Lyon, France.

3Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, University Claude Bernard Lyon 1, Health Services and Performance Research Lab (EA 7425), Lyon, France.

4Adult Intensive Care Unit and Burn Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

5St[è]ve consultants, Oullins, France.

6Department of Anesthesiology and Intensive Care II, Magellan Hospital, University Hospital of Bordeaux, University of Bordeaux 2, Pessac, France.

7Medicosurgical Intensive Care Unit, Pasteur 2, Nice, France.

8IRCAN Unit, UMR INSERM U1081 - CNRS 7284, Nice Sophia-Antipolis University, Nice, France.

9Department of perioperative medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.

10Department of Critical Care Medicine, CHU Nîmes, Nîmes, France.

11Center for Critical Care Nephrology, The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.

*See also p. 340.

A complete list of board members of the AzuRéa Group is as follows: Pierre-François Perrigault, Matthieu Jabaudon, Bernard Allaouchiche, Marc Leone, Jean-Christophe Orban, Matthieu Legrand, Sébastien Perbet, Claire Roger, Jean-Michel Julia, Serge Molliex, Russell Chabanne, François Antonini, Sophie Kauffmann, Pierre-Eric Danin, Thomas Godet, Olivier Langeron, Arnaud Friggeri, Thomas Geeraerts, Laurent Muller, Jacques Ripart, Olivier Baldesi, Saber Barbar, Jérôme Morel, Alain Lepape, Pierre-Marie Bertrand, Jean-Etienne Bazin, Ali Mofredj, Béatrice Riu-Poulenc, Karim Lakhal, Vincent Minville, Emmanuel Futier Philippe Guerci, Emmanuel Novy, Pierre Bouzat, Qin Lu, and Karim Debbat.

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Dr. Bonnassieux disclosed that the study received financial support from Gambro-Hospal-Baxter, however, Gambro-Hospal-Baxter had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the article. Dr. Schneider’s institution received funding from Gambro-Hospal-Baxter, Fresenius Medical Care, and BBraun Avitum. Drs. Schmidt, Bénard, Cancalon’s, and Ichai institutions received funding from Gambro-Hospal-Baxter. Dr. Joannes-Boyau’s institution received funding from Asahi Kasei, and he received funding from Gambro-Hospal-Baxter, BBraun, Merck Sharp and Dohme, and Fresenius Medical Care. Dr. Constantin has received consulting fees or speaker honorarium from Gambro-Hospal-Baxter. Dr. Kellum received funding from Baxter and NxStage. Dr. Rimmelé received consulting fees or speaker honorarium from Gambro-Hospal-Baxter and Fresenius Medical Care. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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