title: Early mortality on continuous renal replacement therapy (CRRT): the prairie CRRT study.
abstract: BACKGROUND
  Patients with acute kidney injury (AKI) requiring renal replacement therapy (RRT) have an increased short-term and long-term risk of mortality. In most North American intensive care units (ICUs), these patients receive continuous renal replacement therapy (CRRT).
  
  
  OBJECTIVE
  We aim to identify clinical and demographic factors associated with mortality within 24 h of initiating CRRT.
  
  
  METHODS
  This paper is a prospective cohort study.
  
  
  METHODS
  The setting involves three ICUs (12-bed surgical ICU, 10-bed medical ICU, and a 7-bed combined ICU for both medical and surgical patients) of the Regina Qu'Appelle Health Region (RQHR) Saskatchewan, Canada.
  
  
  METHODS
  The patients were 106 individuals with AKI who were admitted to the ICUs and received CRRT from April 2013 to September 2014.
  
  
  METHODS
  Date and time of admission, transfer to, and initiation of CRRT were documented. Demographic data, use of vasoactive medications, ventilator settings, pH, urine output, and chronic disease comorbidities were measured.
  
  
  METHODS
  The methods involved a stepwise multiple variable logistic regression model using death within 24 h of starting CRRT as the dependent variable, with significant variables derived from univariate analysis as covariates.
  
  
  RESULTS
  Of the 2634 patients admitted to the ICUs in the study period (April 2013 to September 2014), 83.6 % (2201/2634) had no AKI. Two hundred and sixty-nine or 10.2 % of the patients had stage 3 AKI. One hundred six of the 269 patients (40%) were started on CRRT. Of those on CRRT, 66/106 died in the ICU while on CRRT. Seventeen of the 66 patients (26%) died within 24 h of initiating therapy. In univariate logistic regression models, factors associated with early mortality included fraction of inspired oxygen (per 0.1 unit) (OR 1.39, 95 % CI 1.09-1.77); epinephrine dose >10 μg/min (OR 5.81, 95 % CI 1.86-18.16); vasopressin >0.02 μg/min (OR 3.99, 95 % CI 1.07-14.84); and norepinephrine dose >20 μg/min (OR 11.04, 95 % CI 2.38-51.24) which were associated with early mortality. When included in stepwise multivariate logistic regression analysis, only FiO2 (per 0.1 unit) and the dose of norepinephrine of >20 μg/min were independently associated with early mortality.
  
  
  CONCLUSIONS
  The small sample size was a limitation of this study.
  
  
  CONCLUSIONS
  Patients admitted to the ICU with AKI requiring CRRT have a high risk of early mortality. In these patients, vasopressor use and hypoxia were independently associated with adverse short-term survival.
authors.affiliation: Section of Nephrology, Department of Medicine, Regina Qu'Appelle Health Region, 1440, 14th Avenue, Regina, S4P 0W5 Canada.
authors.forename: Bhanu
authors.identifier: 0000-0002-1139-4821
authors.initials: B
authors.lastname: Prasad
authors.affiliation: College of Medicine, University of Saskatchewan, Saskatoon, S4P 0W5 Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Urbanski
authors.affiliation: Seven Oaks Hospital, 2 PD12, 2300 McPhillips Street, Winnipeg, Manitoba R2V3M3 Canada.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Ferguson
authors.affiliation: Research and Performance Support, Regina Qu'Appelle Health Region, Regina, Saskatchewan S4P 0W5 Canada.
authors.forename: Erwin
authors.initials: E
authors.lastname: Karreman
authors.affiliation: Seven Oaks Hospital, 2 PD12, 2300 McPhillips Street, Winnipeg, Manitoba R2V3M3 Canada.
authors.forename: Nav
authors.initials: N
authors.lastname: Tangri