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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Continuous renal replacement therapy versus intermittent hemodialysis in intensive care patients: impact on mortality and renal recovery
Intensive Care Medicine, Volume 42, No. 9, Year 2016
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Description
Purpose: The best renal replacement therapy (RRT) modality remains controversial. We compared mortality and short- and long-term renal recovery between patients treated with continuous RRT and intermittent hemodialysis. Methods: Patients of the prospective observational multicenter cohort database OUTCOMEREA™ were included if they underwent at least one RRT session between 2004 and 2014. Differences in patients’ baseline and daily characteristics between treatment groups were taken into account by using a marginal structural Cox model, allowing one to substantially reduce the bias resulting from confounding factors in observational longitudinal data analysis. The composite primary endpoint was 30-day mortality and dialysis dependency. Results: Among 1360 included patients with RRT, 544 (40.0 %) and 816 (60.0 %) were initially treated by continuous RRT and intermittent hemodialysis, respectively. At day 30, 39.6 % patients were dead. Among survivors, 23.8 % still required RRT. There was no difference between groups for the primary endpoint in global population (HR 1.00, 95 % CI 0.77–1.29; p = 0.97). In patients with higher weight gain at RRT initiation, mortality and dialysis dependency were significantly lower with continuous RRT (HR 0.54, 95 % CI 0.29–0.99; p = 0.05). Conversely, this technique appeared to be deleterious in patients without shock (HR 2.24, 95 % CI 1.24–4.04; p = 0.01). Six-month mortality and persistent renal dysfunction were not influenced by the RRT modality in patients with dialysis dependence at ICU discharge. Conclusion: Continuous RRT did not appear to improve 30-day and 6-month patient outcomes. It seems beneficial for patients with fluid overload, but might be deleterious in the absence of hemodynamic failure. © 2016, Springer-Verlag Berlin Heidelberg and ESICM.
Authors & Co-Authors
Darmon, Michaël
France, Saint-etienne
Université Jean Monnet Saint Etienne
Bailly, Sébastien D.Sign©bastien
France, Paris
Inserm
France, Saint Martin D'heres
Université Grenoble Alpes
Clec'H, Christophe
France, Paris
Inserm
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
France, Villetaneuse
University Sorbonne Paris Nord
Dupuis, Claire
France, Paris
Inserm
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Misset, Benoıˆt Y.
France, Paris
Groupe Hospitalier Paris Saint-joseph
France, Paris
Université Paris Cité
Azoulay, Elie
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
France, Paris
Université Paris Cité
Schwebel, Carole
France, Saint Martin D'heres
Université Grenoble Alpes
Bouadma, Lila
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Kallel, Hatem
France, Cayenne
Centre Hospitalier de Cayenne
Adrie, Christophe
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Dumenil, Anne Sylvie
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Argaud, Laurent
France, Lyon
Chu de Lyon
Jamali, Samir
Unknown Affiliation
Zaoui, Philippe M.
France, Grenoble
Centre Hospitalier Universitaire de Grenoble
Souweine, Bertrand
France, Clermont-ferrand
Hopital Gabriel Montpied
Timsit, Jéan-François Franc¸ois
France, Paris
Inserm
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
France, Paris
Hôpital Bichat-claude-bernard Ap-hp
Statistics
Citations: 83
Authors: 16
Affiliations: 14
Identifiers
Doi:
10.1007/s00134-016-4404-6
ISSN:
03424642
Research Areas
Health System And Policy
Noncommunicable Diseases
Study Design
Cross Sectional Study
Cohort Study