title: Choice of renal replacement therapy modality in intensive care units: data from a Japanese Nationwide Administrative Claim Database.
abstract: OBJECTIVE
  This study was undertaken to assess recent trends of the choice of renal replacement therapy (RRT) modalities in Japanese intensive care units (ICUs).
  
  
  METHODS
  Data were extracted from the Japanese Diagnosis Procedure Combination database for 2011. We identified adult patients without end-stage renal disease who had been admitted to ICUs for 3 days or longer and started continuous RRT (CRRT) or intermittent RRT (IRRT). Logistic regression was used to analyze which factors affected the modality choice. We further evaluated in-hospital mortality according to the choice of RRT.
  
  
  RESULTS
  Of 7353 eligible patients, 5854 (79.6%) initially received CRRT. The choice of CRRT was independently associated with sex (female), diagnosis of sepsis, hospital type (academic) and volume, vasoactive agents, mechanical ventilation, colloid administration, blood transfusion, intra-aortic balloon pumping, and venoarterial extracorporeal membrane oxygenation. Particularly, the number of vasoactive drugs was strongly associated with the CRRT choice. Overall in-hospital mortality in the CRRT group was higher than that in the IRRT group (50.0% vs 31.1%) and was increased when IRRT was switched to CRRT (59.1%).
  
  
  CONCLUSIONS
  Continuous RRT is apparently preferred in actual ICU practice, especially for hemodynamically unstable patients, and subsequent RRT modality switch is associated with mortality.
authors.affiliation: Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Iwagami
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.affiliation: Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan; Department of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Eisei
authors.initials: E
authors.lastname: Noiri
authors.affiliation: Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.affiliation: Department of Health Informatics and Policy, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.affiliation: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Matsubara
authors.affiliation: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yahagi
authors.affiliation: Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan; Department of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Masaomi
authors.initials: M
authors.lastname: Nangaku
authors.affiliation: Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan; Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan. Electronic address: kdoi-tky@umin.ac.jp.
authors.forename: Kent
authors.initials: K
authors.lastname: Doi
mesh_terms: D058186:Acute Kidney Injury; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy / Q000379:methods*; D012121:Respiration, Artificial
keywords: Acute kidney injury; Continuous renal replacement therapy; Intensive care unit; Intermittent renal replacement therapy