Renal replacement therapy in patients with acute respiratory distress syndrome: a single-center retrospective study

Joshua Dill,1 Billie Bixby,1 Huthayfa Ateeli,1 Benjamin Sarsah,2 Khushboo Goel,3 Ryan Buckley,3 Ilya Finkelshteyn,3 Bijin Thajudeen,2 Pradeep V Kadambi,4 Christian Bime1 1Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, The University of Arizona, Tucson, AZ, USA; 2Division of Nephrology, Department of Medicine, The University of Arizona, Tucson, AZ, USA; 3General Internal Medicine, Department of Medicine, The University of Arizona, Tucson, AZ, USA; 4Department of Medicine, University of Florida College of Medicine – Jacksonville, Jacksonville, FL, USA Background: Patients with acute respiratory distress syndrome (ARDS) who develop acute kidney injury have increased mortality and frequently require renal replacement therapy (RRT). The optimal timing for initiation of RRT after onset of ARDS to improve survival is not known. Methods: We retrospectively reviewed clinical data on patients admitted to our health system over a 2-year period. Individual charts were carefully reviewed to ascertain that patients met the Berlin criteria for ARDS and to categorize RRT utilization. The Kaplan–Meier analysis was conducted to compare early (£48hours postintubation) versus late (>48hours postintubation) initiation of RRT. Associations between RRT initiation and mortality were evaluated using Cox proportional hazards regression. Results: A total of 75 patients were identified with ARDS, 95% of whom received RRT. Mortality of patients who required RRT was 56%. The main indications for RRT initiation were fluid overload (75%), metabolic acidosis (64%), and hyperkalemia (33%). The Kaplan–Meier analysis comparing early initiation of RRT to late initiation of RRT showed no survival benefit. Cox proportional hazard models testing the association between timing of RRT initiation with survival and adjusting for sex, race, ethnicity, and Acute Physiology and Chronic Health Evaluation IIscore did not reach statistical significance (HR=0.94, 95% CI=0.48–1.86). Conclusion: Timing of RRT initiation was not associated with a survival benefit. Prospective study in the utilization and outcomes of RRT in ARDS could assist in optimizing its usage in this population. Keywords: acute respiratory distress syndrome, AKI, dialysis, intensive care, renal