title: Long-term outcomes of end-stage renal disease patients admitted to the ICU.
abstract: 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.
authors.affiliation: Department of medicine, Section of Nephrology, University of Manitoba, Winnipeg, Manitoba. msood99@gmail.com
authors.forename: Manish M
authors.initials: MM
authors.lastname: Sood
authors.forename: Lisa
authors.initials: L
authors.lastname: Miller
authors.forename: Paul
authors.initials: P
authors.lastname: Komenda
authors.forename: Martina
authors.initials: M
authors.lastname: Reslerova
authors.forename: Joe
authors.initials: J
authors.lastname: Bueti
authors.forename: Chris
authors.initials: C
authors.lastname: Santhianathan
authors.forename: Dan
authors.initials: D
authors.lastname: Roberts
authors.forename: Julie
authors.initials: J
authors.lastname: Mojica
authors.forename: Claudio
authors.initials: C
authors.lastname: Rigatto
mesh_terms: D002170:Canada; D002408:Catheters, Indwelling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010530:Peritoneal Dialysis / Q000401:mortality*; D011379:Prognosis; D006435:Renal Dialysis / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate