Long-term outcomes of end-stage renal disease patients admitted to the ICU

[okarol]

Long-term outcomes of end-stage renal disease patients admitted to the ICU
Manish M. Sood1, Lisa Miller1, Paul Komenda1, Martina Reslerova1, Joe Bueti1, Chris Santhianathan1, Dan Roberts2, Julie Mojica2 and Claudio Rigatto1
+ Author Affiliations

1Department of medicine, Section of Nephrology, University of Manitoba, Winnipeg, Manitoba
2Department of medicine, Critical Care Program, Health Sciences Centre, Winnipeg, Manitoba
Correspondence and offprint requests to: Manish M. Sood; E-mail: msood99@gmail.com
Received July 26, 2010.
Accepted December 22, 2010.
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.

Key words
critical care dialysis modality end-stage renal disease long-term mortality vascular access

http://ndt.oxfordjournals.org/content/early/2011/02/15/ndt.gfq835.abstract