Selection and Receipt of Kidney Replacement in Critically Ill Older Patients with AKI.
Anuria
Comorbidity
Critical Care
Critical Illness
Diagnosis-Related Groups
Frailty
Intensive Care Units
Kidney Failure, Chronic
Patient Preference
Prospective Studies
Respiration, Artificial
Survivors
acute kidney injury
decision-making
intensive care unit
mortality
quality of life
renal replacement therapy
Journal
Clinical journal of the American Society of Nephrology : CJASN
ISSN: 1555-905X
Titre abrégé: Clin J Am Soc Nephrol
Pays: United States
ID NLM: 101271570
Informations de publication
Date de publication:
05 04 2019
05 04 2019
Historique:
received:
03
05
2018
accepted:
18
01
2019
pubmed:
23
3
2019
medline:
10
7
2020
entrez:
23
3
2019
Statut:
ppublish
Résumé
Older patients in the intensive care unit are at greater risk of AKI; however, use of kidney replacement therapy in this population is poorly characterized. We describe the triggers and outcomes associated with kidney replacement therapy in older patients with AKI in the intensive care unit. Our study was a prospective cohort study in 16 Canadian hospitals from September 2013 to November 2015. Patients were ≥65 years old, were critically ill, and had severe AKI; exclusion criteria were urgent kidney replacement therapy for a toxin and ESKD. We recorded triggers for kidney replacement therapy (primary exposure), reasons for not receiving kidney replacement therapy, 90-day mortality (primary outcome), and kidney recovery. Of 499 patients, mean (SD) age was 75 (7) years old, Charlson comorbidity score was 3.0 (2.3), and median (interquartile range) Clinical Frailty Scale score was 4 (3-5). Most were receiving mechanical ventilation (64%; Most older, critically ill patients with severe AKI were perceived as candidates for kidney replacement therapy, and approximately one half received therapy. Both willingness to offer kidney replacement therapy and reasons for not starting showed heterogeneity due to a range in patient-specific factors and clinician perceptions of benefit.
Sections du résumé
BACKGROUND AND OBJECTIVES
Older patients in the intensive care unit are at greater risk of AKI; however, use of kidney replacement therapy in this population is poorly characterized. We describe the triggers and outcomes associated with kidney replacement therapy in older patients with AKI in the intensive care unit.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
Our study was a prospective cohort study in 16 Canadian hospitals from September 2013 to November 2015. Patients were ≥65 years old, were critically ill, and had severe AKI; exclusion criteria were urgent kidney replacement therapy for a toxin and ESKD. We recorded triggers for kidney replacement therapy (primary exposure), reasons for not receiving kidney replacement therapy, 90-day mortality (primary outcome), and kidney recovery.
RESULTS
Of 499 patients, mean (SD) age was 75 (7) years old, Charlson comorbidity score was 3.0 (2.3), and median (interquartile range) Clinical Frailty Scale score was 4 (3-5). Most were receiving mechanical ventilation (64%;
CONCLUSIONS
Most older, critically ill patients with severe AKI were perceived as candidates for kidney replacement therapy, and approximately one half received therapy. Both willingness to offer kidney replacement therapy and reasons for not starting showed heterogeneity due to a range in patient-specific factors and clinician perceptions of benefit.
Identifiants
pubmed: 30898872
pii: 01277230-201904000-00006
doi: 10.2215/CJN.05530518
pmc: PMC6450343
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
496-505Subventions
Organisme : CIHR
Pays : Canada
Investigateurs
Sean M Bagshaw
(SM)
R T Noel Gibney
(RTN)
Nadia Baig
(N)
Neill K J Adhikari
(NKJ)
Nicole Marinoff
(N)
Adic Perez
(A)
Karen Burns
(K)
Jan Friedrich
(J)
Julia Lee
(J)
Yoon Lee
(Y)
Kurtis Salway
(K)
Gyan Sandhu
(G)
Orla Smith
(O)
Ron Wald
(R)
Melissa Wang
(M)
Josée Bouchard
(J)
Anatolie Duca
(A)
Francois Lamontagne
(F)
Patrick Bérubé
(P)
Hélène Fournier
(H)
Lauralyn McIntrye
(L)
Irene Watpool
(I)
Rebecca Porteus
(R)
Brigette Gomes
(B)
Jean-François Cailhier
(JF)
Fatna Benettaib
(F)
Peter Dodek
(P)
Betty Jean Ashley
(BJ)
Victoria Alcuaz
(V)
Henry T Stelfox
(HT)
Stacey Ruddell
(S)
Margaret Herridge
(M)
Andrea Matte
(A)
Stephen Lapinsky
(S)
Sumesh Shah
(S)
John Muscedere
(J)
Miranda Hunt
(M)
Ilinca Georgescu
(I)
James Barton
(J)
Dorota Polewicz
(D)
Donald Griesdale
(D)
Denise Foster
(D)
Mark Soth
(M)
Kristine Wachmann
(K)
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 by the American Society of Nephrology.
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