Abstract: FR-PO056
Inpatient Kidney Function Recovery Among Septic Shock Patients Who Initiated Hemodialysis in the Hospital
Session Information
- AKI: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Chen, Joy C. Y., Mayo Clinic, Rochester, Minnesota, United States
- Hu, Bo, Mayo Clinic, Rochester, Minnesota, United States
- Frank, Ryan, Mayo Clinic, Rochester, Minnesota, United States
- Kashani, Kianoush, Mayo Clinic, Rochester, Minnesota, United States
Background
Sepsis and septic shock are life-threatening causes of acute kidney injury (AKI) frequently seen and managed in the intensive care unit. Sepsis-associated AKI independently contributes to the mortality of sepsis. Understanding the potential predictors of recovery may aid in the prevention and management of sepsis-associated AKI. This study aimed to describe the clinical features of septic shock patients who required kidney replacement therapy and to examine the rate of kidney recovery and factors associated with recovery.
Methods
We conducted a retrospective cohort study using data from 229 adult septic shock patients who started in-hospital kidney replacement therapy at Mayo Clinic Rochester medical intensive care unit (MICU) from January 2006 to May 2018. Kidney recovery was defined as sufficient kidney function for stopping kidney replacement therapy prior to hospital discharge. Associations between clinical features and kidney recovery were analyzed with multivariable Fine and Gray regression accounting for death as a competing event.
Results
This cohort consisted of 229 patients with a median (IQR) age of 64 (52-74) years, 55% men, 75% Caucasian, 39% with diabetes, 16% with heart failure, APACHEIII of 105 (84-123) and SOFA of 12 (9-14). Patients received 1,567(524-4,108) mL intravenous fluid in the first 3 hours of resuscitation, 92% required vasopressor support and 83% required mechanical ventilation. The median MICU and hospital stays were 7(4-13) and 19 (10-31) days, respectively. Total kidney replacement duration was 7 (3.5-17.1) days. 41% patients discontinued dialysis prior to discharge and 38% died. Higher volume of fluid resuscitation in the first 3 hours (HR 1.07; CI 1.01-1.14; p = 0.03) and diabetes (HR 1.75; CI 1.17-2.61; p = 0.006) were associated with kidney recovery.
Conclusion
Among septic shock patients who initiated kidney replacement therapy in MICU, 41% recovered kidney function prior to hospital discharge. A higher initial fluid resuscitation volume was associated with recovery, and interestingly, patients with diabetes had a higher chance of recovery.
Kidney recovery stratified by A Fluid in 1st 3 hrs; B Diabetes