End-stage Renal Disease Patients on Renal Replacement Therapy in the Intensive Care Unit: Short- And Long-Term Outcome

Crit Care Med. 2008 Oct;36(10):2773-8. doi: 10.1097/CCM.0b013e318187815a.

Abstract

Objective: The number of patients with end-stage renal disease has increased during the last decades. Data shows that 10% of the renal replacement therapy population in the intensive care unit are patients with end-stage renal disease. We aimed to describe the short- and long-term outcome of these patients after renal replacement therapy in the intensive care unit.

Design: Nationwide cohort study between the years 1995 and 2004. Follow-up up to 5 years.

Setting: Swedish general intensive care units and Swedish hospitals.

Patients: Eligible subjects were end-stage renal disease patients treated with renal replacement therapy in 32 Swedish general intensive care units. In total, 245 patients were studied.

Interventions: None.

Measurements and main results: Short- and long-term mortality was studied. Logistic regression was used to analyze short-term mortality. Long-term mortality was compared with the mortality of end-stage renal disease patients outside the intensive care unit and the mortality in the population. Diabetes and heart failure are significant risk factors for 90-day mortality, with an odds ratio of 1.9 and 2.0, respectively. The intensive care unit end-stage renal disease cohort had increased long-term mortality as compared with non-intensive care unit end-stage renal disease patients, relative risk of death 2.32 (confidence interval 1.84-2.92). A comparison with the mortality rate in the general population yielded a standardized mortality ratio of 25 (95% confidence interval: 19.6-31.4).

Conclusions: For end-stage renal disease patients in the intensive care unit, age, diabetes mellitus, and heart failure are risk factors for 90-day mortality. Long-term mortality is associated with age and heart failure. The long-term mortality of end-stage renal disease patients surviving the intensive care unit stay is significantly higher compared with end-stage renal disease patients without a known intensive care unit admission.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Cause of Death*
  • Cohort Studies
  • Confidence Intervals
  • Female
  • Hospital Mortality / trends*
  • Humans
  • Intensive Care Units*
  • Kaplan-Meier Estimate
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / mortality*
  • Kidney Failure, Chronic / therapy*
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Poisson Distribution
  • Probability
  • Renal Dialysis / methods
  • Renal Dialysis / mortality*
  • Retrospective Studies
  • Risk Assessment
  • Sex Factors
  • Survival Analysis
  • Sweden
  • Time Factors