Mortality rate comparison after switching from continuous to prolonged intermittent renal replacement for acute kidney injury in three intensive care units from different countries

Mark R. Marshall, Julie M. Creamer, Michelle Foster, Tian M. Ma, Susan L. Mann, Enrico Fiaccadori, Umberto Maggiore, Brent Richards, Vanessa L. Wilson, Anthony B. Williams, Alan P N Rankin

Research output: Contribution to journalArticleResearchpeer-review

38 Citations (Scopus)

Abstract

Background. Prolonged intermittent renal replacement therapy (PIRRT) is a dialysis modality for critically ill patients that in theory combines the superior detoxification and haemodynamic stability of the continuous renal replacement therapy (CRRT) with the operational convenience, reduced haemorrhagic risk and low cost of conventional intermittent haemodialysis. However, the extent to which PIRRT should replace these other modalities is uncertain because comparative studies of mortality are lacking. We retrospectively examined the mortality data from three general intensive care units (ICUs) in different countries that have switched their predominant therapeutic approach from CRRT to PIRRT. We assessed whether this practice change was associated with a change in mortality rate.Methods. Data were analysed from ICUs in New Zealand, Australia and Italy. The study population comprised all patients requiring renal replacement therapy from 1 January 1995 to 31 December 2005 (n = 1347), the period of time spanning the change from CRRT to PIRRT in each unit. Poisson regression models were used to estimate the incident rate ratio (IRR) for death, comparing the periods before and after change to PIRRT in each unit. Estimates were adjusted for patient illness severity (APACHE II score) and for the underlying time trend in mortality rate over time.Results. The change from CRRT to PIRRT was not associated with any increase in mortality rate, with an adjusted IRR of 1.02 (0.611.71). The IRR was virtually identical in the three ICUs (P-value = 0.63 for the difference in the IRR between ICUs).Conclusions. Switching from CRRT to PIRRT was not associated with a change in mortality rate. Pending the results of a randomized trial, our study provides evidence that PIRRT might be equivalent to CRRT in the general ICU patient.

Original languageEnglish
Pages (from-to)2169-2175
Number of pages7
JournalNephrology Dialysis Transplantation
Volume26
Issue number7
DOIs
Publication statusPublished - Jul 2011

Fingerprint

Renal Replacement Therapy
Acute Kidney Injury
Intensive Care Units
Kidney
Mortality
APACHE
New Zealand
Critical Illness
Italy

Cite this

Marshall, Mark R. ; Creamer, Julie M. ; Foster, Michelle ; Ma, Tian M. ; Mann, Susan L. ; Fiaccadori, Enrico ; Maggiore, Umberto ; Richards, Brent ; Wilson, Vanessa L. ; Williams, Anthony B. ; Rankin, Alan P N. / Mortality rate comparison after switching from continuous to prolonged intermittent renal replacement for acute kidney injury in three intensive care units from different countries. In: Nephrology Dialysis Transplantation. 2011 ; Vol. 26, No. 7. pp. 2169-2175.
@article{d860a534a5a646309676dd9b62738f70,
title = "Mortality rate comparison after switching from continuous to prolonged intermittent renal replacement for acute kidney injury in three intensive care units from different countries",
abstract = "Background. Prolonged intermittent renal replacement therapy (PIRRT) is a dialysis modality for critically ill patients that in theory combines the superior detoxification and haemodynamic stability of the continuous renal replacement therapy (CRRT) with the operational convenience, reduced haemorrhagic risk and low cost of conventional intermittent haemodialysis. However, the extent to which PIRRT should replace these other modalities is uncertain because comparative studies of mortality are lacking. We retrospectively examined the mortality data from three general intensive care units (ICUs) in different countries that have switched their predominant therapeutic approach from CRRT to PIRRT. We assessed whether this practice change was associated with a change in mortality rate.Methods. Data were analysed from ICUs in New Zealand, Australia and Italy. The study population comprised all patients requiring renal replacement therapy from 1 January 1995 to 31 December 2005 (n = 1347), the period of time spanning the change from CRRT to PIRRT in each unit. Poisson regression models were used to estimate the incident rate ratio (IRR) for death, comparing the periods before and after change to PIRRT in each unit. Estimates were adjusted for patient illness severity (APACHE II score) and for the underlying time trend in mortality rate over time.Results. The change from CRRT to PIRRT was not associated with any increase in mortality rate, with an adjusted IRR of 1.02 (0.611.71). The IRR was virtually identical in the three ICUs (P-value = 0.63 for the difference in the IRR between ICUs).Conclusions. Switching from CRRT to PIRRT was not associated with a change in mortality rate. Pending the results of a randomized trial, our study provides evidence that PIRRT might be equivalent to CRRT in the general ICU patient.",
author = "Marshall, {Mark R.} and Creamer, {Julie M.} and Michelle Foster and Ma, {Tian M.} and Mann, {Susan L.} and Enrico Fiaccadori and Umberto Maggiore and Brent Richards and Wilson, {Vanessa L.} and Williams, {Anthony B.} and Rankin, {Alan P N}",
year = "2011",
month = "7",
doi = "10.1093/ndt/gfq694",
language = "English",
volume = "26",
pages = "2169--2175",
journal = "Proceedings of the European Dialysis and Transplant Association - European Renal Association. European Dialysis and Transplant Association - European Renal Association. Congress",
issn = "0931-0509",
publisher = "OXFORD UNIV PRESS",
number = "7",

}

Marshall, MR, Creamer, JM, Foster, M, Ma, TM, Mann, SL, Fiaccadori, E, Maggiore, U, Richards, B, Wilson, VL, Williams, AB & Rankin, APN 2011, 'Mortality rate comparison after switching from continuous to prolonged intermittent renal replacement for acute kidney injury in three intensive care units from different countries' Nephrology Dialysis Transplantation, vol. 26, no. 7, pp. 2169-2175. https://doi.org/10.1093/ndt/gfq694

Mortality rate comparison after switching from continuous to prolonged intermittent renal replacement for acute kidney injury in three intensive care units from different countries. / Marshall, Mark R.; Creamer, Julie M.; Foster, Michelle; Ma, Tian M.; Mann, Susan L.; Fiaccadori, Enrico; Maggiore, Umberto; Richards, Brent; Wilson, Vanessa L.; Williams, Anthony B.; Rankin, Alan P N.

In: Nephrology Dialysis Transplantation, Vol. 26, No. 7, 07.2011, p. 2169-2175.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Mortality rate comparison after switching from continuous to prolonged intermittent renal replacement for acute kidney injury in three intensive care units from different countries

AU - Marshall, Mark R.

AU - Creamer, Julie M.

AU - Foster, Michelle

AU - Ma, Tian M.

AU - Mann, Susan L.

AU - Fiaccadori, Enrico

AU - Maggiore, Umberto

AU - Richards, Brent

AU - Wilson, Vanessa L.

AU - Williams, Anthony B.

AU - Rankin, Alan P N

PY - 2011/7

Y1 - 2011/7

N2 - Background. Prolonged intermittent renal replacement therapy (PIRRT) is a dialysis modality for critically ill patients that in theory combines the superior detoxification and haemodynamic stability of the continuous renal replacement therapy (CRRT) with the operational convenience, reduced haemorrhagic risk and low cost of conventional intermittent haemodialysis. However, the extent to which PIRRT should replace these other modalities is uncertain because comparative studies of mortality are lacking. We retrospectively examined the mortality data from three general intensive care units (ICUs) in different countries that have switched their predominant therapeutic approach from CRRT to PIRRT. We assessed whether this practice change was associated with a change in mortality rate.Methods. Data were analysed from ICUs in New Zealand, Australia and Italy. The study population comprised all patients requiring renal replacement therapy from 1 January 1995 to 31 December 2005 (n = 1347), the period of time spanning the change from CRRT to PIRRT in each unit. Poisson regression models were used to estimate the incident rate ratio (IRR) for death, comparing the periods before and after change to PIRRT in each unit. Estimates were adjusted for patient illness severity (APACHE II score) and for the underlying time trend in mortality rate over time.Results. The change from CRRT to PIRRT was not associated with any increase in mortality rate, with an adjusted IRR of 1.02 (0.611.71). The IRR was virtually identical in the three ICUs (P-value = 0.63 for the difference in the IRR between ICUs).Conclusions. Switching from CRRT to PIRRT was not associated with a change in mortality rate. Pending the results of a randomized trial, our study provides evidence that PIRRT might be equivalent to CRRT in the general ICU patient.

AB - Background. Prolonged intermittent renal replacement therapy (PIRRT) is a dialysis modality for critically ill patients that in theory combines the superior detoxification and haemodynamic stability of the continuous renal replacement therapy (CRRT) with the operational convenience, reduced haemorrhagic risk and low cost of conventional intermittent haemodialysis. However, the extent to which PIRRT should replace these other modalities is uncertain because comparative studies of mortality are lacking. We retrospectively examined the mortality data from three general intensive care units (ICUs) in different countries that have switched their predominant therapeutic approach from CRRT to PIRRT. We assessed whether this practice change was associated with a change in mortality rate.Methods. Data were analysed from ICUs in New Zealand, Australia and Italy. The study population comprised all patients requiring renal replacement therapy from 1 January 1995 to 31 December 2005 (n = 1347), the period of time spanning the change from CRRT to PIRRT in each unit. Poisson regression models were used to estimate the incident rate ratio (IRR) for death, comparing the periods before and after change to PIRRT in each unit. Estimates were adjusted for patient illness severity (APACHE II score) and for the underlying time trend in mortality rate over time.Results. The change from CRRT to PIRRT was not associated with any increase in mortality rate, with an adjusted IRR of 1.02 (0.611.71). The IRR was virtually identical in the three ICUs (P-value = 0.63 for the difference in the IRR between ICUs).Conclusions. Switching from CRRT to PIRRT was not associated with a change in mortality rate. Pending the results of a randomized trial, our study provides evidence that PIRRT might be equivalent to CRRT in the general ICU patient.

UR - http://www.scopus.com/inward/record.url?scp=79960026116&partnerID=8YFLogxK

U2 - 10.1093/ndt/gfq694

DO - 10.1093/ndt/gfq694

M3 - Article

VL - 26

SP - 2169

EP - 2175

JO - Proceedings of the European Dialysis and Transplant Association - European Renal Association. European Dialysis and Transplant Association - European Renal Association. Congress

JF - Proceedings of the European Dialysis and Transplant Association - European Renal Association. European Dialysis and Transplant Association - European Renal Association. Congress

SN - 0931-0509

IS - 7

ER -