Higher versus Lower Continuous Renal Replacement Therapy Intensity in Critically ill Patients with Liver Dysfunction

Higher versus Lower Continuous Renal Replacement Therapy Intensity in Critically ill Patients with Liver Dysfunction. O'Brien, Z, Cass, A, Cole, L, Finfer, S, Gallagher, M, McArthur, C, McGuiness, S, Myburgh, J, Bellomo, R, & M\aartensson, J Blood Purification, 45(1-3):36–43, 2018. Number: 1-3

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\textlessb\textgreater\textlessi\textgreaterAims:\textless/i\textgreater\textless/b\textgreater To study the association between higher versus lower continuous renal replacement therapy (CRRT) intensity and mortality in critically ill patients with combined acute kidney injury and liver dysfunction. \textlessb\textgreater\textlessi\textgreaterMethods:\textless/i\textgreater\textless/b\textgreater Post-hoc analysis of patients with liver dysfunction (Sequential Organ Failure Assessment liver score ≥2 or diagnosis of liver failure/transplant) included in the Randomized Evaluation of Normal versus Augmented Level renal replacement therapy (RENAL) trial. \textlessb\textgreater\textlessi\textgreaterResults:\textless/i\textgreater\textless/b\textgreater Of 444 patients, 210 (47.3%) were randomized to higher intensity (effluent flow 40 mL/kg/h) and 234 (52.7%) to lower intensity (effluent flow 25 mL/kg/h) therapy. Overall, 79 and 86% of prescribed effluent flow was delivered in the higher-intensity and lower-intensity groups, respectively (\textlessi\textgreaterp\textless/i\textgreater \textless 0.001). In total, 113 (54.1%) and 120 (51.3%) patients died in each group. On multivariable Cox regression analysis, we found no independent association between higher CRRT intensity and mortality (HR 0.93, 95% CI 0.70-1.24; \textlessi\textgreaterp\textless/i\textgreater = 0.642). \textlessb\textgreater\textlessi\textgreaterConclusions:\textless/i\textgreater\textless/b\textgreater In RENAL patients with liver dysfunction, higher CRRT intensity was not associated with reduced mortality.

@article{obrien_higher_2018,
	title = {Higher versus {Lower} {Continuous} {Renal} {Replacement} {Therapy} {Intensity} in {Critically} ill {Patients} with {Liver} {Dysfunction}},
	volume = {45},
	issn = {0253-5068},
	url = {https://www.karger.com/DOI/10.1159/000480224},
	doi = {10.1159/000480224},
	abstract = {{\textbackslash}textlessb{\textbackslash}textgreater{\textbackslash}textlessi{\textbackslash}textgreaterAims:{\textbackslash}textless/i{\textbackslash}textgreater{\textbackslash}textless/b{\textbackslash}textgreater To study the association between higher versus lower continuous renal replacement therapy (CRRT) intensity and mortality in critically ill patients with combined acute kidney injury and liver dysfunction. {\textbackslash}textlessb{\textbackslash}textgreater{\textbackslash}textlessi{\textbackslash}textgreaterMethods:{\textbackslash}textless/i{\textbackslash}textgreater{\textbackslash}textless/b{\textbackslash}textgreater Post-hoc analysis of patients with liver dysfunction (Sequential Organ Failure Assessment liver score ≥2 or diagnosis of liver failure/transplant) included in the Randomized Evaluation of Normal versus Augmented Level renal replacement therapy (RENAL) trial. {\textbackslash}textlessb{\textbackslash}textgreater{\textbackslash}textlessi{\textbackslash}textgreaterResults:{\textbackslash}textless/i{\textbackslash}textgreater{\textbackslash}textless/b{\textbackslash}textgreater Of 444 patients, 210 (47.3\%) were randomized to higher intensity (effluent flow 40 mL/kg/h) and 234 (52.7\%) to lower intensity (effluent flow 25 mL/kg/h) therapy. Overall, 79 and 86\% of prescribed effluent flow was delivered in the higher-intensity and lower-intensity groups, respectively ({\textbackslash}textlessi{\textbackslash}textgreaterp{\textbackslash}textless/i{\textbackslash}textgreater {\textbackslash}textless 0.001). In total, 113 (54.1\%) and 120 (51.3\%) patients died in each group. On multivariable Cox regression analysis, we found no independent association between higher CRRT intensity and mortality (HR 0.93, 95\% CI 0.70-1.24; {\textbackslash}textlessi{\textbackslash}textgreaterp{\textbackslash}textless/i{\textbackslash}textgreater = 0.642). {\textbackslash}textlessb{\textbackslash}textgreater{\textbackslash}textlessi{\textbackslash}textgreaterConclusions:{\textbackslash}textless/i{\textbackslash}textgreater{\textbackslash}textless/b{\textbackslash}textgreater In RENAL patients with liver dysfunction, higher CRRT intensity was not associated with reduced mortality.},
	number = {1-3},
	journal = {Blood Purification},
	author = {O'Brien, Z and Cass, A and Cole, L and Finfer, S and Gallagher, M and McArthur, C and McGuiness, S and Myburgh, J and Bellomo, R and M{\textbackslash}aartensson, J},
	year = {2018},
	note = {Number: 1-3},
	pages = {36--43},
}

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