Low-dose continuous kidney replacement therapy ups mortality in critically ill patients

A lower delivered continuous kidney replacement therapy (CKRT) dose appears to be detrimental to critically ill patients with acute kidney injury (AKI), with a study showing that such an approach is associated with a higher 90-day mortality rate.

For the retrospective study, researchers reviewed the medical records of 494 critically ill patients (median age 72 years, 62.6 percent men) with AKI treated with CKRT at a tertiary Japanese university hospital.

Multivariable Cox regression and Kaplan–Meier analyses were used to evaluate the effect of delivered CKRT doses below or above the median on mortality 90 days after CKRT initiation.

In the cohort, acute tubular injury was the leading cause of AKI, accounting for 81.8 percent of the cases. The median delivered CKRT dose was 13.2 mL/kg/h. Most of the patients (92.3 percent) received delivered CKRT doses below 20 mL/kg/h, and 41.3 percent died within 90 days after CKRT initiation.

Delivered CKRT below the median was associated with a 73-percent increase in the risk of 90-day mortality (hazard ratio, 1.73, 95 percent confidence interval, 1.19–2.51, p=0.004). Of note, a significant, inverse, nonlinear association emerged between 90-day mortality and delivered CKRT dose when delivered CKRT dose was used as a continuous variable.