Longer Continuous Renal Replacement Therapy Increases Mortality Risk After Surgery

Some patients in the surgical intensive care unit (SICU) who undergo 7 or more days of continuous renal replacement therapy (CRRT) face a significantly increased risk of mortality, according to a recent study.

For their retrospective cohort study, the researchers evaluated 108 SICU patients undergoing CRRT in an urban tertiary medical center from July 1, 2012, until January 1, 2016. A total of 55 patients were awaiting a liver transplant and were categorized in the pre-transplant group, while 53 patients were categorized in the general surgical group.
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Of the 55 patients in the pre-transplant group, 22 required 7 or more days of CRRT, while 12 of 53 patients in the general surgical group required 7 or more days of CRRT.

Demographic information indicated that 59.3% of patients were male, and mean patient age was 62 years.

The results showed that general surgical SICU patients who required longer durations of CRRT faced a significantly higher risk of mortality, while risk among pre-transplant patients was likely not related to CRRT. All 12 of the general surgical patients who required 7 or more days of CRRT had died, whereas 13 of the 22 pre-transplant patients who required 7 or more days of CRRT had died.

“Continuous renal replacement therapy is valuable for surgical patients with an acute and correctable indication; however, survival decreases significantly with increasing duration of CRRT,” the researchers concluded. “Duration of CRRT does not correlate with survival among patients awaiting liver transplant.”

—Christina Vogt

Reference:

Tatum JM, Barmparas G, Ko A, et al. Analysis of survival after initiation of continuous renal replacement therapy in a surgical intensive care unit [Published online June 21, 2017]. JAMA Surg. doi:10.1001/jamasurg.2017.1673.