Choice of renal replacement therapy modality in intensive care units: data from a Japanese Nationwide Administrative Claim Database

Masao Iwagami; Hideo Yasunaga; Eisei Noiri; Hiromasa Horiguchi; Kiyohide Fushimi; Takehiro Matsubara; Naoki Yahagi; Masaomi Nangaku; Kent Doi

doi:10.1016/j.jcrc.2014.11.003

Choice of renal replacement therapy modality in intensive care units: data from a Japanese Nationwide Administrative Claim Database

J Crit Care. 2015 Apr;30(2):381-5. doi: 10.1016/j.jcrc.2014.11.003. Epub 2014 Nov 13.

Authors

Masao Iwagami¹, Hideo Yasunaga², Eisei Noiri³, Hiromasa Horiguchi⁴, Kiyohide Fushimi⁵, Takehiro Matsubara⁶, Naoki Yahagi⁶, Masaomi Nangaku³, Kent Doi⁷

Affiliations

¹ Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan.
² Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
³ Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan; Department of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan.
⁴ Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan.
⁵ Department of Health Informatics and Policy, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
⁶ Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
⁷ Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan; Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan. Electronic address: kdoi-tky@umin.ac.jp.

PMID: 25434720
DOI: 10.1016/j.jcrc.2014.11.003

Abstract

Purpose: This study was undertaken to assess recent trends of the choice of renal replacement therapy (RRT) modalities in Japanese intensive care units (ICUs).

Materials and methods: Data were extracted from the Japanese Diagnosis Procedure Combination database for 2011. We identified adult patients without end-stage renal disease who had been admitted to ICUs for 3 days or longer and started continuous RRT (CRRT) or intermittent RRT (IRRT). Logistic regression was used to analyze which factors affected the modality choice. We further evaluated in-hospital mortality according to the choice of RRT.

Results: Of 7353 eligible patients, 5854 (79.6%) initially received CRRT. The choice of CRRT was independently associated with sex (female), diagnosis of sepsis, hospital type (academic) and volume, vasoactive agents, mechanical ventilation, colloid administration, blood transfusion, intra-aortic balloon pumping, and venoarterial extracorporeal membrane oxygenation. Particularly, the number of vasoactive drugs was strongly associated with the CRRT choice. Overall in-hospital mortality in the CRRT group was higher than that in the IRRT group (50.0% vs 31.1%) and was increased when IRRT was switched to CRRT (59.1%).

Conclusions: Continuous RRT is apparently preferred in actual ICU practice, especially for hemodynamically unstable patients, and subsequent RRT modality switch is associated with mortality.

Keywords: Acute kidney injury; Continuous renal replacement therapy; Intensive care unit; Intermittent renal replacement therapy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acute Kidney Injury
Adult
Aged
Aged, 80 and over
Databases, Factual
Female
Hospital Mortality
Humans
Intensive Care Units
Kidney Failure, Chronic / mortality
Kidney Failure, Chronic / therapy*
Logistic Models
Male
Middle Aged
Renal Replacement Therapy / methods*
Respiration, Artificial