Comparison of outcomes of different modalities of renal replacement therapy in patients of acute kidney injury: a single centre prospective observational study
Published Online: Dec 28, 2023
Page range: 138 - 149
Received: Feb 26, 2023
DOI: https://doi.org/10.2478/rjim-2023-0033
Keywords
Acute Kidney Injury (AKI), Renal Replacement Therapy (RRT), IHD (Intermittent Hemodialysis), CRRT (Continuous Renal Replacement Therapy), SLED (Sustained Low-Efficiency Dialysis), MAP (Mean Arterial Pressure), UO (Urine Output), BU (Blood Urea), SCr (Serum Creatinine), SOFA score (Sequential Organ Failure Assessment score)
© 2023 H. K. Aggarwal et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Background
Acute Kidney Injury (AKI) is one of the most important causes of in-hospital mortality. The global burden of AKI continues to rise without a marked reduction in mortality. As such, the use of renal replacement therapy (RRT) forms an integral part of AKI management, especially in critically ill patients. There has been much debate over the preferred modality of RRT between continuous, intermittent and intermediate modes. While there is abundant data from Europe and North America, data from tropical countries especially the Indian subcontinent is sparse. Our study aims to provide an Indian perspective on the dialytic management of tropical AKI in a tertiary care hospital setup.
Methods
90 patients of AKI, 30 each undergoing Continuous Renal Replacement Therapy (CRRT), Intermittent Hemodialysis (IHD) and SLED (Sustained Low-Efficiency Dialysis) were included in this prospective cohort study. At the end of 28 days of hospital stay, discharge or death, outcome measures were ascertained which included mortality, duration of hospital stay, recovery of renal function and requirement of RRT after discharge. In addition median of the net change of renal parameters was also computed across the three groups. Lastly, Kaplan Meier analysis was performed to assess the probability of survival with the use of each modality of RRT.
Results
There was no significant difference in the primary outcome of mortality between the three cohorts (p=0.27). However, CRRT was associated with greater renal recovery (p= 0.015) than IHD or SLED. On the other hand, SLED and IHD were associated with a greater net reduction in blood urea (p=0.004) and serum creatinine (p=0.053).
Conclusion
CRRT, IHD and SLED are all complementary to each other and are viable options in the treatment of AKI patients.