Journal Article

Long-term outcomes of end-stage renal disease patients admitted to the ICU

Manish M. Sood, Lisa Miller, Paul Komenda, Martina Reslerova, Joe Bueti, Chris Santhianathan, Dan Roberts, Julie Mojica and Claudio Rigatto

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 26, issue 9, pages 2965-2970
Published in print September 2011 | ISSN: 0931-0509
Published online February 2011 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfq835
Long-term outcomes of end-stage renal disease patients admitted to the ICU

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Background. End-stage renal disease (ESRD) patients admitted to the intensive care unit (ICU) have poor survival and high rates of readmission; however, little evidence exists on long-term outcomes. We set out to investigate the long-term (6 and 12 months) survival of ESRD patients admitted to the ICU and whether differential survival could be explained by dialysis modality and vascular access.

Methods. We compared the admission characteristics, outcomes and readmission rates of 619 ESRD [95 peritoneal dialysis (PD), 334 hemodialysis with a catheter (HD CVC), 190 hemodialysis with an AV fistula (HD AVF)] patients admitted to 11 ICU’s in Winnipeg, Manitoba, Canada. Parametric and nonparametric tests were used as appropriate to determine differences in baseline characteristics. Multivariable Cox and logistic regression was used to assess outcomes between the groups.

Results. The 6- and 12-month crude survival was 62 and 52%, respectively. In a univariate model, modality and vascular access were associated with an increased hazard ratio (HR) of death [PD HR 1.60 95% confidence interval (CI) 1.20–2.13, HD CVC HR 1.55 95% CI 1.25–1.93] compared to patients on HD with an AVF. In three different multivariate adjusted models, this association persisted with HRs for death of 1.63–1.75 for PD and 1.50–1.58 for HD CVC.

Conclusions. Overall long-term survival of ESRD patients after admission to the ICU is poor. Being on PD or being dialyzed with a catheter was independently associated with an increased mortality.

Keywords: critical care; dialysis modality; end-stage renal disease; long-term mortality; vascular access

Journal Article.  3740 words.  Illustrated.

Subjects: Nephrology

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