COMPARISON OF MODES OF RENAL REPLACEMENT THERAPIES IN INTENSIVE CARE UNIT. A PROSPECTIVE OBSERVATIONAL STUDY.

Dr Srinivas Jakkinaboina; Dr Shafi Mozammil; Dr Mohan Shankarji Maharaj; Dr Sateesh Thammiraju

Volume : V, Issue : XI, November - 2016

COMPARISON OF MODES OF RENAL REPLACEMENT THERAPIES IN INTENSIVE CARE UNIT. A PROSPECTIVE OBSERVATIONAL STUDY.

Dr Srinivas Jakkinaboina, Dr Shafi Mozammil, Dr Mohan Shankarji Maharaj, Dr Sateesh Thammiraju

Abstract :

Introduction - Acute Kidney Injury (AKI) is an independent predictor of mortality and associated with End Stage Renal Disease. Evidence suggests no survival benefit with different modalities of Renal Replacement therapies (RRT). Aim – To Evaluate the modes of Renal Replacement therapies and outcomes in the Intensive care unit (ICU). Methods - A Prospective observational study done for a period of 6 months at 6 Intensive care units associated with Apollo Health City. All patients admitted to the ICU with AKI requiring RRT were eligible to enroll. Exclusion Criteria were post cardiac arrest, age less than 18 years, chronic kidney disease and DNR (do not resuscitate) status. The Primary end point was In-hospital mortality. The following were the parameters monitored Age, Sex, mode of RRT, indication of RRT, Comorbidities, source of sepsis, vasopressors, cumulative balance at RRT, ICU and hospital length of stay, mechanical ventilation duration, APACHE II and SOFA score at admission. Results- The total number of patients were 75 which were grouped into Intermittent hemodialysis 14 patients (IHD), Sustained low efficiency dialysis 34 patients (SLED), Continuous renal replacement therapy 27 patients (CRRT). The In- hospital mortality in IHD, SLED and CRRT were 0, 52.94, 37.03 % respectively. The statistically significant factors influencing the increased mortality rate in the SLED and CRRT group were age >56years , ICU length of stay >11days, hospital length of stay >19days, Comorbidities > 2, mechanical ventilation duration >10 days, vasopressors>1, SOFA score >10 at RRT, Blood urea >130 mg/dl at the RRT and serum creatinine >4mg/dl at RRT. . The patients with septic shock in SLED group and CRRT group were 82.34% and 37.03% respectively. 92% of our study group are medical patients. The In-hospital and 30 day mortality in the SLED group is more than the IHD and CRRT. The Mechanical ventilator days, ICU and hospital length of stay is more in the SLED group compared with IHD and CRRT group. The ICU free days is more in CRRT group than SLED and IHD group. CONCLUSIONS- The In-hospital mortality in IHD was 0%. The In-hospital mortality in the CRRT group is less than SLED group. The In-hospital mortality is increased by increased age, increased ICU and hospital length of stay, Comorbidities more than 2, increased mechanical ventilation duration, vasopressors >1. Further randomized study with more number of patients are required to validate the superiority of the RRT mode