Feasibility study evaluating neurological impairment in critically ill dialysis patients

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E-Poster

https://storage.unitedwebnetwork.com/files/1099/1f45e36312eecde20bc1aceb277886e9.pdf

Abstract Title

First Name *

Natasha

Last Name *

Jawa

Co-author 1

Samuel Silver samuel.silver@queensu.ca Queen's University

Co-author 2

Rachel Holden rachel.holden@kingstonhsc.ca Queen's University

Co-author 3

Steven Scott steve.scott@queensu.ca Queen's University

Co-author 4

Andrew Day daya@queensu.ca Queen's University

Co-author 5

Patrick Norman patrick.norman@kingstonhsc.ca Kingston General Health Research Institute

Co-author 6

Benjamin Kwan benjamin.kwan@kingstonhsc.ca Queen's University

Co-author 7

David Maslove david.maslove@queensu.ca Queen's University

Co-author 8

John Muscedere john.muscedere@kingstonhsc.ca Queen's University

Co-author 9

J. Gordon Boyd gordon.boyd@kingstonhsc.ca Queen's University

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Acute kidney injury (AKI) resulting in kidney replacement therapy (KRT) is rising among critically ill adults. Long-term KRT and critical illness are independently linked to acute (i.e., delirium) and prolonged cognitive impairment and structural brain pathology. Poor regional cerebral oxygenation (rSO2) may be a contributing factor. This study sought to determine whether undertaking a longitudinal study of critically ill patients initiated on KRT was feasible. We aimed to identify barriers to enrolment and data collection, to design mitigation strategies for a future study exploring the neurological issues facing this cohort.

Methods

We enrolled adults greater than or equal to 18 years with severe AKI stage 2/3 within 12-hours of initiating continuous KRT (CKRT) or intermittent hemodialysis in the Kingston Health Sciences Centre Intensive Care Unit (ICU). rSO2 was monitored during the first 72h of CKRT or throughout each intermittent hemodialysis session. We measured acute neurological impairment by daily delirium screening (Confusion Assessment Method), and long-term neurocognitive outcomes using the Kinarm robot, Repeatable Battery for the Assessment of Neuropsychological Status, and brain MRI. Feasibility was assessed through 1) enrolment (defined as greater than or equal to 1 per month), 2) data capture rates (greater than or equal to 80%), and 3) follow-up rates at 3- and 12-months (greater than or equal to 70%).

Results

Of 484 ICU patients, 26 met screening criteria. Two declined, and 13 met at least one exclusion criteria. Eleven were enrolled. Eight died in ICU, one died two months after discharge, and one declined follow-up. Data capture rates were high: rSO2/vitals (91.3%), delirium screening/demographics (100%). Longitudinal testing was completed in 50% (1 of 2) of survivors. Enrolment was low due to a variety of factors, limiting our ability to evaluate long-term outcomes.

Conclusions

It is feasible to collect cerebral oxygenation and delirium data in critically ill patients undergoing kidney replacement therapy. Long-term follow-up may be challenging due to high mortality.

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