Comparison of urine output among patients treated with more intensive versus less intensive RRT: Results from the acute renal failure trial network study

Finnian R. McCausland, Josephine Asafu-Adjei, Rebecca Betensky, Paul M. Palevsky, Sushrut S. Waikar

Research output: Contribution to journalArticle

Abstract

Background and objectives Intensive RRT may have adverse effects that account for the absence of benefit observed in randomized trials of more intensive versus less intensive RRT. We wished to determine the association of more intensive RRT with changes in urine output as a marker of worsening residual renal function in critically ill patients with severe AKI. Design, setting, participants, & measurements The Acute Renal Failure Trial Network Study (n=1124) was a multicenter trial that randomized critically ill patients requiring initiation of RRT tomore intensive (hemodialysis or sustained low-efficiency dialysis six times per week or continuous venovenous hemodiafiltration at 35 ml/kg per hour) versus less intensive (hemodialysis or sustained low-efficiency dialysis three times per week or continuous venovenous hemodiafiltration at 20 ml/kg per hour) RRT. Mixed linear regression models were fit to estimate the association of RRT intensity with change in daily urine output in survivors through day 7 (n=871); Cox regression models were fit to determine the association of RRT intensity with time to ≥50% decline in urine output in all patients through day 28. Results Mean age of participants was 60615 years old, 72% were men, and 30% were diabetic. In unadjusted models, among patients who survived ≥7 days, mean urine output was, on average, 31.7 ml/d higher (95% confidence interval, 8.2 to 55.2 ml/d) for the less intensive group compared with the more intensive group (P=0.01). More intensive RRT was associated with 29% greater unadjusted risk of decline in urine output of ≥50% (hazard ratio, 1.29; 95% confidence interval, 1.10 to 1.51). Conclusions More intensive versus less intensive RRT is associated with a greater reduction in urine output during the first 7 days of therapy and a greater risk of developing a decline in urine output of ≥50%in critically ill patients with severe AKI.

Original languageEnglish (US)
Pages (from-to)1335-1342
Number of pages8
JournalClinical Journal of the American Society of Nephrology
Volume11
Issue number8
DOIs
StatePublished - Jan 1 2016

Fingerprint

Acute Kidney Injury
Urine
Critical Illness
Hemodiafiltration
Renal Dialysis
Dialysis
Linear Models
Confidence Intervals
Proportional Hazards Models
Multicenter Studies
Survivors
Kidney

Keywords

  • Acute kidney injury
  • critical illness
  • hemodialysis
  • Humans
  • Randomized trials as topic
  • renal dialysis
  • renal replacement therapy

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Comparison of urine output among patients treated with more intensive versus less intensive RRT : Results from the acute renal failure trial network study. / McCausland, Finnian R.; Asafu-Adjei, Josephine; Betensky, Rebecca; Palevsky, Paul M.; Waikar, Sushrut S.

In: Clinical Journal of the American Society of Nephrology, Vol. 11, No. 8, 01.01.2016, p. 1335-1342.

Research output: Contribution to journalArticle

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abstract = "Background and objectives Intensive RRT may have adverse effects that account for the absence of benefit observed in randomized trials of more intensive versus less intensive RRT. We wished to determine the association of more intensive RRT with changes in urine output as a marker of worsening residual renal function in critically ill patients with severe AKI. Design, setting, participants, & measurements The Acute Renal Failure Trial Network Study (n=1124) was a multicenter trial that randomized critically ill patients requiring initiation of RRT tomore intensive (hemodialysis or sustained low-efficiency dialysis six times per week or continuous venovenous hemodiafiltration at 35 ml/kg per hour) versus less intensive (hemodialysis or sustained low-efficiency dialysis three times per week or continuous venovenous hemodiafiltration at 20 ml/kg per hour) RRT. Mixed linear regression models were fit to estimate the association of RRT intensity with change in daily urine output in survivors through day 7 (n=871); Cox regression models were fit to determine the association of RRT intensity with time to ≥50{\%} decline in urine output in all patients through day 28. Results Mean age of participants was 60615 years old, 72{\%} were men, and 30{\%} were diabetic. In unadjusted models, among patients who survived ≥7 days, mean urine output was, on average, 31.7 ml/d higher (95{\%} confidence interval, 8.2 to 55.2 ml/d) for the less intensive group compared with the more intensive group (P=0.01). More intensive RRT was associated with 29{\%} greater unadjusted risk of decline in urine output of ≥50{\%} (hazard ratio, 1.29; 95{\%} confidence interval, 1.10 to 1.51). Conclusions More intensive versus less intensive RRT is associated with a greater reduction in urine output during the first 7 days of therapy and a greater risk of developing a decline in urine output of ≥50{\%}in critically ill patients with severe AKI.",
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