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 journalReview articlepeer-review

Abstract

Objectives: To determine the incidence and characteristics of intensive care unit (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.

Settings: We analysed admissions to Scottish intensive care environments between 1 January 2009 to 31 December 2019.

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

Intervention: None

Measurements: Descriptive statistics and factors associated with mortality using logistic regression and Cox proportional hazard models.
Main Results: From 10,657 unique individuals registered in the Scottish Renal Registry over the 11-year study period and alive as of 1st January 2009, 1402 adult patients were identified as being admitted to a Scottish critical care setting. Between 2009 and 2019, admissions to ICU increased in a non-linear 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 versus 19.9 per 1000 person-years) but post-ICU mortality was similar (about 24% at 30 days and 40% at 1-year). Admissions for renal reasons were most common (20.9%) in patients undergoing chronic dialysis whilst 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 were 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 are rising in the chronic KRT population. Mortality post ICU admission is high for these patients.
Original languageEnglish
Number of pages11
JournalCritical Care Medicine
Early online date15 Nov 2022
DOIs
Publication statusE-pub ahead of print - 15 Nov 2022

Keywords

  • Kidney failure
  • Kidney Replacement Therapy
  • Critical Care
  • Intensive Care Unit
  • Mortality

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