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Abstract: SA-OR05

Impact of Using Blood Warmer During Continuous Kidney Replacement Therapy on Adverse Kidney Events and Mortality

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Abbasi, Aisha, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
  • Doddi, Akshith, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
  • Ramesh, Ambika, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
  • Sakhuja, Ankit, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
  • Shawwa, Khaled, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
Background

Hypothermia is a complication of continuous kidney replacement therapy (CKRT). Blood rewarming is often used to prevent hypothermia; however, its impact on adverse kidney outcomes is unknown.

Methods

Patients with acute kidney injury (AKI) who required CKRT between 1/1/2012 and 1/1/2021 and admitted at a tertiary academic hospital were included. Major adverse kidney events (MAKE) is a composite outcome of need of kidney replacement therapy, doubling of the serum creatinine from baseline or death. We assessed MAKE at 30 and 90 days after CKRT initiation.

Results

There were 669 patients with AKI that required CKRT during the study period. There were 324 (48%) patients in whom a blood warmer was used on first day of CKRT. Patients where a blood warmer was used were more likely to be diagnosed with sepsis/septic shock (81% vs 74%, p=0.04), and were in a less positive fluid balance at the time of CKRT initiation (1.0 vs 1.3 L, p=0.03) compared to patients where a blood warmer was not used. There was no difference in hypotensive episodes during first day of CKRT between the two groups. MAKE-30 and MAKE-90 occurred in 376 (56%) and 422 (63%) of the patients, respectively. Patients who developed MAKE-30 were older (62 vs 56) and had higher SOFA score (10.5 vs 9), higher norepinephrine equivalent (NEE) requirement (0.15 vs 0.07 mcg/kg/min), higher lactate (5.5 vs 3.3 mmol/L), higher Charlson comorbidity index (CCI) (8 vs 7), lower mean arterial pressure (MAP) (74 vs 80 mmHg) and were more likely to be requiring mechanical ventilation (75% vs 63%) at CKRT initiation compared to patients who did not develop MAKE-30, p<0.001. Baseline creatinine was not different between the two groups (1.2 mg/dl). After adjusting for age, CCI, baseline serum creatinine and SOFA score, lactate, MAP, mechanical ventilation and NEE at CKRT initiation, the use of a blood warmer was independently associated with MAKE-30 (OR: 1.6, 95% C): 1.1-2.2, p=0.009) but not MAKE-90 (OR: 1.3, 95% CI 0.9-1.98, p-value=0.1). In adjusted Cox proportional hazard model, use of blood warmer was independently associated with mortality: hazard ratio 1.33 (95% CI: 1.1-1.6, p=0.002).

Conclusion

Blood warming techniques were associated with worse outcomes in patients with AKI on CKRT. More studies are required to explain this relationship.

Funding

  • Other NIH Support