Sergio Vesconi , Dinna N Cruz , Roberto Fumagalli , Detlef Kindgen-Milles , Gianpaola Monti , Anibal Marinho , Filippo Mariano , Marco Formica , Mariano Marchesi , Robert Rene , Sergio Livigni , Claudio Ronco and The DO-RE-MI Study Group
Critical Care 2009, 13:R57doi:10.1186/cc7784; Published: 15 April 2009
Abstract (provisional)
Background
Optimal dialysis dose for the treatment of acute kidney injury (AKI) is controversial. We sought to evaluate the relationship between renal replacement therapy (RRT) dose and outcome.
Methods
We performed a prospective multicenter observational study in 30 intensive care units (ICUs) in 8 countries from June 2005 to December 2007. Delivered RRT dose was calculated in patients treated exclusively with either continuous (CRRT) or intermittent RRT (IRRT) during their ICU stay. Dose was categorized into more-intensive (CRRT [greater than or equal to] 35ml/kg/hr, IRRT [greater than or equal to] 6sessions/week) or less-intensive (CRRT < 35ml/kg/hr, IRRT < 6sessions/week). The main outcome measures were ICU mortality, ICU length of stay, and duration of mechanical ventilation.
Results
Of 15,200 critically ill patients admitted during the study period, 553 AKI patients were treated with RRT, including 338 who received CRRT only and 87 IRRT only. For CRRT, the median delivered dose was 27.1(IQR 22.1,33.9) ml/kg/hr. For IRRT, the median dose was 7(IQR 5,7) sessions/week. Only 22% of CRRT patients and 64% of IRRT patients received a more-intensive dose. Crude ICU mortality among CRRT patients were 60.8% vs. 52.5% (more- vs. less-intensive groups, respectively). In IRRT, this was 23.6 vs. 19.4%, respectively. On multivariable analysis, there was no significant association between RRT dose and ICU mortality (Odds Ratio [OR] more- vs. less-intensive: CRRT 1.21, 95%CI 0.66 to 2.21; IRRT 1.50, 95%CI 0.48 to 4.67). Among survivors, shorter ICU stay and duration of mechanical ventilation were observed in the more-intensive RRT groups [more- vs. less-intensive for all: CRRT 15 (IQR 8,26) vs. 19.5 (IQR 12,33.5) ICU days, P = 0.063; 7 (IQR 4,17) vs. 14 (IQR 5,24) ventilation days, P = 0.031; IRRT 8 (IQR 5.5,14) vs. 18 (IQR 13,35) ICU days, P = 0.008; 2.5 (IQR 0,10) vs. 12 (IQR 3,24) ventilation days], P = 0.026.
Conclusions
After adjustment for multiple variables, these data provide no evidence for a survival benefit afforded by higher dose RRT. However, more-intensive RRT was associated with a favorable effect on ICU stay and duration of mechanical ventilation among survivors. This deserves further exploration. Trial Registration: Cochrane Renal Group (CRG110600093)
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