title: Renal replacement therapy in the critical patient: treatment variation over time.
abstract: OBJECTIVE
  To analyze the evolution of patients subjected to renal replacement therapy (RRT), and to determine risk factors associated with mortality and the recovery of renal function.
  
  
  METHODS
  A prospective, observational study of critically ill patients.
  
  
  METHODS
  Clinical-surgical Intensive Care Unit (ICU) of Sabadell Hospital (Spain).
  
  
  METHODS
  Inclusion of all patients treated in our Unit due to acute renal failure (ARF) requiring RRT.
  
  
  METHODS
  We recorded epidemiological data, severity using the APACHE II score, days of the technique, ICU mortality, and renal function recovery. The study period was divided into 2 parts: part 1 (2000-2004) and part 2 (2005-2009). The 2 periods were compared using the Student t-test for continuous variables and the chi-squared test for categorical variables. Multiple regression analysis was performed to determine the risk factors for mortality and recovery of renal function.
  
  
  RESULTS
  A total of 304 patients were treated. Sepsis was the main etiology of ARF (61%), involving principally respiratory and abdominal foci. In the second period the convective technique and community-acquired ARF were far more prevalent than in the first period. There were fewer days of therapy in the second period (19.7 versus 12.3 days; P=.015). Total ICU mortality was 52.3%, with a decrease in the last period (61.9% to 45.5%: P=.003). The risk factors associated to mortality were creatinine upon admission (odds ratio [OR] 0.77; 95% confidence interval [95%CI] 0.61-0.97) and treatment with IHD alone (OR 0.37, 95%CI 0.16-0.87). Survivors had normal renal function at ICU discharge in 56.7% of the cases in the second period, vs in 72.9% in the first period, with more patients subjected to IHD in the second period (10.4% versus 26.8%). The factors related to the recovery of renal function were creatinine upon admission (OR 1.98, 95%CI 1.12-3.48), acute renal failure (OR 0.11, 95%CI 0.04-0.34) and treatment with continuous techniques (OR 0.18, 95%CI 0.03-0.85).
  
  
  CONCLUSIONS
  Mortality among critically ill patients subjected to RRT has improved in recent years.
authors.affiliation: Centre de Crítics, Hospital de Sabadell, Corporació Sanitària i Universitària Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, CIBER Enfermedades Respiratorias, Spain. anavas@tauli.cat
authors.forename: A
authors.initials: A
authors.lastname: Navas
authors.forename: R
authors.initials: R
authors.lastname: Ferrer
authors.forename: M
authors.initials: M
authors.lastname: Martínez
authors.forename: M L
authors.initials: ML
authors.lastname: Martínez
authors.forename: C
authors.initials: C
authors.lastname: de Haro
authors.forename: A
authors.initials: A
authors.lastname: Artigas
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality / Q000628:therapy*; D000368:Aged; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D006435:Renal Dialysis; D012307:Risk Factors