TY - JOUR
T1 - Incidence and Outcomes of Patients Receiving Chronic Kidney Replacement Therapy Admitted to Scottish ICUs Between 2009 and 2019—A National Observational Cohort Study
AU - Lambourg, Emilie
AU - Walker, Heather
AU - Campbell, Jacqueline
AU - Watters, Chrissie
AU - O'Neill, Martin
AU - Donaldson, Lorraine
AU - Siddiqui, Moneeza K.
AU - Almond, Alison
AU - Buck, Katharine
AU - Cousland, Zoe
AU - Joss, Nicola
AU - Metcalfe, Wendy
AU - Methven, Shona
AU - Sanu, Vinod
AU - Spalding, Elaine
AU - Traynor, Jamie P.
AU - Lone, Nazir I.
AU - Bell, Samira T.
AU - The Scottish Renal Registry (SRR)
N1 - Funding Information:
Dr. Bell received funding from Astra Zeneca. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Copyright:
© 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
PY - 2023/1
Y1 - 2023/1
N2 - 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.
AB - 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.
KW - critical care
KW - intensive care unit
KW - kidney failure
KW - kidney replacement therapy
KW - mortality
UR - http://www.scopus.com/inward/record.url?scp=85144259732&partnerID=8YFLogxK
U2 - 10.1097/CCM.0000000000005710
DO - 10.1097/CCM.0000000000005710
M3 - Article
C2 - 36377890
SN - 0090-3493
VL - 51
SP - 69
EP - 79
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 1
ER -