PMID- 17021268
OWN - NLM
STAT- MEDLINE
DCOM- 20070604
LR  - 20071203
IS  - 1046-6673 (Print)
IS  - 1046-6673 (Linking)
VI  - 17
IP  - 11
DP  - 2006 Nov
TI  - Survival by dialysis modality in critically ill patients with acute kidney 
      injury.
PG  - 3132-8
AB  - Among critically ill patients, acute kidney injury (AKI) requiring dialysis is 
      associated with mortality rates generally in excess of 50%. Continuous renal 
      replacement therapies (CRRT) often are recommended and widely used, although data 
      to support its superiority over intermittent hemodialysis (IHD) are lacking. Data 
      from the Program to Improve Care in Acute Renal Disease (PICARD), a multicenter 
      observational study of AKI, were analyzed. Among 398 patients who required 
      dialysis, the risk for death within 60 d was examined by assigned initial 
      dialysis modality (CRRT [n = 206] versus IHD [n = 192]) using standard 
      Kaplan-Meier product limit estimates, proportional hazards ("Cox") regression 
      methods, and a propensity score approach to account for selection effects. Crude 
      survival rates were lower for patients who were treated with CRRT than IHD 
      (survival at 30 d 45 versus 58%; P = 0.006). Adjusted for age, hepatic failure, 
      sepsis, thrombocytopenia, blood urea nitrogen, and serum creatinine and 
      stratified by site, the relative risk for death associated with CRRT was 1.82 
      (95% confidence interval 1.26 to 2.62). Further adjustment for the propensity 
      score did not materially alter the association (relative risk 1.92; 95% 
      confidence interval 1.28 to 2.89). Among critically ill patients with AKI, CRRT 
      was associated with increased mortality. Although the results could reflect 
      residual confounding by severity of illness, these data provide no evidence for a 
      survival benefit afforded by CRRT. Larger, prospective, randomized clinical 
      trials to compare CRRT and IHD in severe AKI are needed.
FAU - Cho, Kerry C
AU  - Cho KC
AD  - Division of Nephrology, Department of Medicine, University of California San 
      Francisco, San Francisco, CA 94118, USA.
FAU - Himmelfarb, Jonathan
AU  - Himmelfarb J
FAU - Paganini, Emil
AU  - Paganini E
FAU - Ikizler, T Alp
AU  - Ikizler TA
FAU - Soroko, Sharon H
AU  - Soroko SH
FAU - Mehta, Ravindra L
AU  - Mehta RL
FAU - Chertow, Glenn M
AU  - Chertow GM
LA  - eng
GR  - R01-DK53411/DK/NIDDK NIH HHS/United States
GR  - R01-DK53412/DK/NIDDK NIH HHS/United States
GR  - R01-DK53413/DK/NIDDK NIH HHS/United States
GR  - R33-DK67645/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, N.I.H., Extramural
DEP - 20061004
PL  - United States
TA  - J Am Soc Nephrol
JT  - Journal of the American Society of Nephrology : JASN
JID - 9013836
SB  - IM
MH  - Acute Disease
MH  - Critical Illness/mortality/therapy
MH  - Female
MH  - Humans
MH  - Kidney Diseases/*mortality/*therapy
MH  - Male
MH  - Middle Aged
MH  - Renal Dialysis/*methods
MH  - Survival Rate
EDAT- 2006/10/06 09:00
MHDA- 2007/06/05 09:00
CRDT- 2006/10/06 09:00
PHST- 2006/10/06 09:00 [pubmed]
PHST- 2007/06/05 09:00 [medline]
PHST- 2006/10/06 09:00 [entrez]
AID - ASN.2006030268 [pii]
AID - 10.1681/ASN.2006030268 [doi]
PST - ppublish
SO  - J Am Soc Nephrol. 2006 Nov;17(11):3132-8. doi: 10.1681/ASN.2006030268. Epub 2006 
      Oct 4.