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Acute kidney injury (AKI) is a common complication in critically ill patients and is associated with increased short- and long-term morbidity, hospital mortality, and chronic kidney disease with the risk of chronic dialysis. The incidence of AKI in the intensive care unit (ICU) ranges from approximately 30% to 60% of critically ill patients.
Renal support therapy (RST) is a cornerstone of treatment in critically ill patients; however, its application is not without adverse events, including hemodynamic instability and the risk of chronic dialysis.
Intradialytic hemodynamic instability in critically ill patients is a possible and potentially life-threatening condition, in a potential risk of ESRD.
Objective: To correlate episodes of arterial hypotension during Renal Support Therapy (RST) in patients admitted to the Intensive Care Unit (ICU) and assess their impact on patient outcomes. The primary outcome is mortality associated with intradialytic hypotension (IDH). Secondary outcomes include the impact of IDH events on outcomes measured by Major Adverse Kidney Events (MAKE) at 90 days, which includes a decrease in glomerular filtration rate (GFR), the need for chronic dialysis, and mortality.
An epidemiological, observational, retrospective study conducted on 113 adult patients admitted to the Hospital Británico (Buenos Aires, Argentina) between January and December 2021, requiring RST. Epidemiological, clinical, and laboratory data were an univariate analysis was performed.
Episodes of intradialytic hypotension (IDH) were defined as systolic blood pressure < 90 mmHg or mean arterial pressure < 65 mmHg. Hypotension events were analyzed using a logistic regression model.
Sample characteristics:
A total of 113 patients were included over a 12-month period. The median age was 70 years (IQR 53-67), 74% were male, and the recorded mortality was 64.60%. For the APACHE II and SOFA variables, the median was 18 (IQR 14-21) and 12 (IQR 9-14), respectively, with a median ICU stay of 18 days (IQR 6.5-29.5).
Primary Objective:
A logistic regression model was used to estimate the relationship between mortality and IDH events. The deviation analysis shows a statistically significant correlation between the variables (p<0.0001), with a confidence level of 95%. The model has an R2 of 24.63% (the model can explain 1 in 4 cases). OR(x)=1.0481. To illustrate the results better, we can infer that the presence of IDH events is associated with increased mortality, rejecting the null hypothesis.
Secondary Objective:
A hypothesis test was conducted to measure the impact of IDH events on the outcomes of survivors at 90 days. We found no statistically significant relationship for mortality (p>0.05) and dialysis dependence (>0.05). The multivariate analysis comparing baseline GFR and GFR at 90 days between patients with and without IDH events showed no significant differences, but the sample size is small, and more cases need to be evaluated.
Through the analyzed data, we have confirmed a causal relationship between IDH events and mortality in ICU patients with AKI-D. However, no significant differences were found in renal survival, dialysis dependence, and all-cause mortality at 90 days. Since this study was conducted at a single center, further research is needed to obtain more robust results.