Incidence and Outcomes of Patients Receiving Chronic Kidney Replacement Therapy Admitted to Scottish ICUs Between 2009 and 2019—A National Observational Cohort Study

Emilie Lambourg, Heather Walker, Jacqueline Campbell, Chrissie Watters, Martin O'Neill, Lorraine Donaldson, Moneeza K. Siddiqui, Alison Almond, Katharine Buck, Zoe Cousland, Nicola Joss, Wendy Metcalfe, Shona Methven, Vinod Sanu, Elaine Spalding, Jamie P. Traynor, Nazir I. Lone, Samira T. Bell (Lead / Corresponding author), The Scottish Renal Registry (SRR)

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
53 Downloads (Pure)

Abstract

Objectives: To determine the incidence and characteristics of ICU admissions in the Scottish population of patients treated with chronic kidney replacement therapy (KRT) over an 11-year period and determine factors associated with post-ICU admission mortality.

Design: Retrospective observational cohort study.

Setting: We analyzed admissions to Scottish intensive care environments between January 1, 2009, and December 31, 2019.

Patients: All patients receiving chronic KRT - including maintenance dialysis and kidney transplant - in Scotland.

Intervention: None.

Measurements and Main Results: Descriptive statistics and factors associated with mortality using logistic regression and Cox proportional hazard models. From 10,657 unique individuals registered in the Scottish Renal Registry over the 11-year study period and alive as of January 1, 2009, 1,402 adult patients were identified as being admitted to a Scottish critical care setting. Between 2009 and 2019, admissions to ICU increased in a nonlinear manner driven by increases in admissions for renal causes and elective cardiac surgery. The ICU admission rate was higher among patients on chronic dialysis than in kidney transplant recipients (59.1 vs 19.9 per 1,000 person-years), but post-ICU mortality was similar (about 24% at 30 d and 40% at 1 year). Admissions for renal reasons were most common (20.9%) in patients undergoing chronic dialysis, whereas kidney transplant recipients were most frequently admitted for pneumonia (19.3%) or sepsis (12.8%). Adjusted Cox PH models showed that receiving invasive ventilation and vasoactive drugs was associated with an increased risk of death at 30 days post-ICU admission (HR, 1.75; 95% CI, 1.28-2.39 and 1.72; 95% CI, 1.28-2.31, respectively).

Conclusions: With a growing population of kidney transplant recipients and the improved survival of patients on chronic dialysis, the number of ICU admissions is rising in the chronic KRT population. Mortality post-ICU admission is high for these patients.

Original languageEnglish
Pages (from-to)69-79
Number of pages11
JournalCritical Care Medicine
Volume51
Issue number1
Early online date15 Nov 2022
DOIs
Publication statusPublished - Jan 2023

Keywords

  • critical care
  • intensive care unit
  • kidney failure
  • kidney replacement therapy
  • mortality

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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