Outcome in critically ill medical patients treated with renal replacement therapy for acute renal failure: comparison between patients with and those without haematological malignancies.
BACKGROUND
Starting renal replacement therapy (RRT) for acute renal failure in critically ill patients with haematological malignancies is controversial because of the poor outcome and high costs. The aim of this study was to compare the outcome between critically ill medical patients with and without haematological malignancies who received RRT for acute renal failure.


METHODS
We retrospectively collected data on all consecutive patients who received RRT for acute renal failure at the Medical Intensive Care Unit (ICU) of a University Hospital between 1997 and 2002, and assessed the impact of the presence of a haematological malignancy on the survival within 6 months after ICU admission by Cox proportional hazard models.


RESULTS
Fifty of the 222 (22.5%) consecutive patients with haematological malignancies admitted to the ICU over the study period received RRT for acute renal failure compared with 248 of the 4293 (5.8%) patients without haematological malignancies (P<0.001). Among patients who received RRT, those with haematological malignancies had higher crude ICU (79.6 vs 55.7%, P=0.002) and in-hospital (83.7 vs 66.1%, P=0.016) mortality rates, and a higher mortality at 6 months (86 vs 72%, P=0.018) by Kaplan-Meier estimates compared with those without haematological malignancies. However, after adjustment for the severity of illness and the duration of hospitalization before ICU admission, haematological malignancy by itself was no longer associated with a higher risk of death (hazard ratio 1.04; 95% confidence interval, 0.73-1.54, P=0.78).


CONCLUSIONS
Medical ICU patients with haematological malignancies have a higher rate of occurrence of acute renal failure treated with RRT and a higher mortality, compared with those without haematological malignancies. However, the presence of a haematological malignancy by itself is not a reason to withhold RRT in medical ICU patients with acute renal failure.
Benoit
Dominique D
DD
Department of Internal Medicine, Intensive Care Medicine, Medical Intensive Care Unit, 12K12IB, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium. dominique.benoit@Ugent.be
Hoste
Eric A
EA
Depuydt
Pieter O
PO
Offner
Fritz C
FC
Lameire
Norbert H
NH
Vandewoude
Koenraad H
KH
Dhondt
Annemieke W
AW
Noens
Lucien A
LA
Decruyenaere
Johan M
JM
D058186:Acute Kidney Injury / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D000328:Adult; D000368:Aged; D016638:Critical Illness; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome