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Impact of intradialytic hypotension on mortality following the transition from continuous renal replacement therapy to intermittent hemodialysis

Kim, Seong Geun ; Yun, Donghwan ; Lee, Jinwoo ; [et al.]

The Korean Society of Critical Care Medicine ; 2023

In: Acute and Critical Care Vol. 38, No. 1 ( 2023-02-28), p. 86-94

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In: Acute and Critical Care, The Korean Society of Critical Care Medicine, Vol. 38, No. 1 ( 2023-02-28), p. 86-94

Abstract: Background: The transition of dialysis modalities from continuous renal replacement therapy (CRRT) to intermittent hemodialysis (iHD) is frequently conducted during the recovery phase of critically ill patients with acute kidney injury. Herein, we addressed the occurrence of intradialytic hypotension (IDH) after this transition, and its association with the mortality risk.Methods: A total of 541 patients with acute kidney injury who attempted to transition from CRRT to iHD at Seoul National University Hospital, Korea from 2010 to 2020 were retrospectively collected. IDH was defined as a discontinuation of dialysis because of hemodynamic instability plus a nadir systolic blood pressure 〈 90 mm Hg or a decrease in systolic blood pressure ≥30 mm Hg during the first session of iHD. Odds ratios (ORs) of outcomes, such as in-hospital mortality and weaning from RRT, were measured using a logistic regression model after adjusting for multiple variables.Results: IDH occurred in 197 patients (36%), and their mortality rate (44%) was higher than that of those without IDH (19%; OR, 2.64; 95% confidence interval [CI], 1.70–4.08). For patients exhibiting IDH, the iHD sessions delayed successful weaning from RRT (OR, 0.62; 95% CI, 0.43–0.90) compared with sessions on those without IDH. Factors such as low blood pressure, high pulse rate, low urine output, use of mechanical ventilations and vasopressors, and hypoalbuminemia were associated with IDH risk.Conclusions: IDH occurrence following the transition from CRRT to iHD is associated with high mortality and delayed weaning from RRT.

Type of Medium: Online Resource

ISSN: 2586-6052 , 2586-6060

URL: Article

DOI: 10.4266/acc.2022.00948

Language: English

Publisher: The Korean Society of Critical Care Medicine

Publication Date: 2023

detail.hit.zdb_id: 3003021-3

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Hyperlactatemia is a predictor of mortality in patients undergoing continuous renal replacement therapy for acute kidney injury

Kim, Seong Geun ; Lee, Jinwoo ; Yun, Donghwan ; [et al.]

Springer Science and Business Media LLC ; 2023

In: BMC Nephrology Vol. 24, No. 1 ( 2023-01-14)

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In: BMC Nephrology, Springer Science and Business Media LLC, Vol. 24, No. 1 ( 2023-01-14)

Abstract: Hyperlactatemia occurs frequently in critically ill patients, and this pathologic condition leads to worse outcomes in several disease subsets. Herein, we addressed whether hyperlactatemia is associated with the risk of mortality in patients undergoing continuous renal replacement therapy (CRRT) due to acute kidney injury. Methods A total of 1,661 patients who underwent CRRT for severe acute kidney injury were retrospectively reviewed between 2010 and 2020. The patients were categorized according to their serum lactate levels, such as high (≥ 7.6 mmol/l), moderate (2.1–7.5 mmol/l) and low (≤ 2 mmol/l), at the time of CRRT initiation. The hazard ratios (HRs) for the risk of in-hospital mortality were calculated with adjustment of multiple variables. The increase in the area under the receiver operating characteristic curve (AUROC) for the mortality risk was evaluated after adding serum lactate levels to the Sequential Organ Failure Assessment (SOFA) and the Acute Physiology and Chronic Health Evaluation (APACHE) II score-based models. Results A total of 802 (48.3%) and 542 (32.6%) patients had moderate and high lactate levels, respectively. The moderate and high lactate groups had a higher risk of mortality than the low lactate group, with HRs of 1.64 (1.22–2.20) and 4.18 (2.99–5.85), respectively. The lactate-enhanced models had higher AUROCs than the models without lactates (0.764 vs. 0.702 for SOFA score; 0.737 vs. 0.678 for APACHE II score). Conclusions Hyperlactatemia is associated with mortality outcomes in patients undergoing CRRT for acute kidney injury. Serum lactate levels may need to be monitored in this patient subset.

Type of Medium: Online Resource

ISSN: 1471-2369

URL: Article

DOI: 10.1186/s12882-023-03063-y

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2023

detail.hit.zdb_id: 2041348-8

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Longitudinal trajectory of acidosis and mortality in acute kidney injury requiring continuous renal replacement therapy

Lee, Jinwoo ; Kim, Seong Geun ; Yun, Donghwan ; [et al.]

Springer Science and Business Media LLC ; 2022

In: BMC Nephrology Vol. 23, No. 1 ( 2022-12-26)

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In: BMC Nephrology, Springer Science and Business Media LLC, Vol. 23, No. 1 ( 2022-12-26)

Abstract: Acidosis frequently occurs in severe acute kidney injury (AKI), and continuous renal replacement therapy (CRRT) can control this pathologic condition. Nevertheless, acidosis may be aggravated; thus, monitoring is essential after starting CRRT. Herein, we addressed the longitudinal trajectory of acidosis on CRRT and its relationship with worse outcomes. Methods The latent growth mixture model was applied to classify the trajectories of pH during the first 24 hours and those of C-reactive protein (CRP) after 24 hours on CRRT due to AKI ( n = 1815). Cox proportional hazard models were used to calculate hazard ratios of all-cause mortality after adjusting multiple variables or matching their propensity scores. Results The patients could be classified into 5 clusters, including the normally maintained groups (1st cluster, pH = 7.4; and 2nd cluster, pH = 7.3), recovering group (3rd cluster with pH values from 7.2 to 7.3), aggravating group (4th cluster with pH values from 7.3 to 7.2), and ill-being group (5th cluster, pH 〈 7.2). The pH clusters had different trends of C-reactive protein (CRP) after 24 hours; the 1st and 2nd pH clusters had lower levels, but the 3rd to 5th pH clusters had an increasing trend of CRP. The 1st pH cluster had the best survival rates, and the 3rd to 5th pH clusters had the worst survival rates. This survival difference was significant despite adjusting for other variables or matching propensity scores. Conclusions Initial trajectories of acidosis determine subsequent worse outcomes, such as mortality and inflammation, in patients undergoing CRRT due to AKI.

Type of Medium: Online Resource

ISSN: 1471-2369

URL: Article

DOI: 10.1186/s12882-022-03047-4

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2022

detail.hit.zdb_id: 2041348-8

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Consulting to nephrologist when starting continuous renal replacement therapy for acute kidney injury is associated with a survival benefit

Lee, Jinwoo ; Kim, Seong Geun ; Yun, Donghwan ; [et al.]

Public Library of Science (PLoS) ; 2023

In: PLOS ONE Vol. 18, No. 2 ( 2023-2-15), p. e0281831-

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In: PLOS ONE, Public Library of Science (PLoS), Vol. 18, No. 2 ( 2023-2-15), p. e0281831-

Abstract: Several studies suggest improved outcomes for patients with kidney disease who consult a nephrologist. However, it remains undetermined whether a consultation with a nephrologist is related to a survival benefit after starting continuous renal replacement therapy (CRRT) due to acute kidney injury (AKI). Methods Data from 2,397 patients who started CRRT due to severe AKI at Seoul National University Hospital, Korea between 2010 and 2020 were retrospectively collected. The patients were divided into two groups according to whether they underwent a nephrology consultation regarding the initiation and maintenance of CRRT. The Cox proportional hazards model was used to calculate the hazard ratio (HR) of mortality during admission to the intensive care unit after adjusting for multiple variables. Results A total of 2,153 patients (89.8%) were referred to nephrologists when starting CRRT. The patients who underwent a nephrology consultation had a lower mortality rate than those who did not have a consultation (HR = 0.47 [0.40–0.56]; P 〈 0.001). Subsequently, patients who had nephrology consultations were divided into two groups (i.e., early and late) according to the timing of the consultation. Both patients with early and late consultation had lower mortality rates than patients without consultations, with HRs of 0.45 (0.37–0.54) and 0.51 (0.42–0.61), respectively. Conclusions Consultation with a nephrologist may contribute to a survival benefit after starting CRRT for AKI.

Type of Medium: Online Resource

ISSN: 1932-6203

URL: Article

DOI: 10.1371/journal.pone.0281831

DOI: 10.1371/journal.pone.0281831.g001

DOI: 10.1371/journal.pone.0281831.g002

DOI: 10.1371/journal.pone.0281831.g003

DOI: 10.1371/journal.pone.0281831.g004

DOI: 10.1371/journal.pone.0281831.t001

DOI: 10.1371/journal.pone.0281831.t002

DOI: 10.1371/journal.pone.0281831.t003

DOI: 10.1371/journal.pone.0281831.t004

DOI: 10.1371/journal.pone.0281831.t005

DOI: 10.1371/journal.pone.0281831.s001

DOI: 10.1371/journal.pone.0281831.s002

DOI: 10.1371/journal.pone.0281831.s003

Language: English

Publisher: Public Library of Science (PLoS)

Publication Date: 2023

detail.hit.zdb_id: 2267670-3

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Risk of ventricular tachycardia and its outcomes in patients undergoing continuous renal replacement therapy due to acute kidney injury

Kim, Seong Geun ; Yun, Donghwan ; Kim, Jayoun ; [et al.]

The Korean Society of Nephrology ; 2023

In: Kidney Research and Clinical Practice Vol. 42, No. 3 ( 2023-05-31), p. 370-378

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In: Kidney Research and Clinical Practice, The Korean Society of Nephrology, Vol. 42, No. 3 ( 2023-05-31), p. 370-378

Abstract: Background: Despite efforts to treat critically ill patients who require continuous renal replacement therapy (CRRT) due to acute kidney injury (AKI), their mortality risk remains high. This condition may be attributable to complications of CRRT, such as arrhythmias. Here, we addressed the occurrence of ventricular tachycardia (VT) during CRRT and its relationship with patient outcomes. Methods: This study retrospectively enrolled 2,397 patients who started CRRT due to AKI from 2010 to 2020 at Seoul National University Hospital in Korea. The occurrence of VT was evaluated from the initiation of CRRT until weaning from CRRT. The odds ratios (ORs) of mortality outcomes were measured using logistic regression models after adjustment for multiple variables.Results: VT occurred in 150 patients (6.3%) after starting CRRT. Among them, 95 cases were defined as sustained VT (i.e., lasting ≥30 seconds), and the other 55 cases were defined as non-sustained VT (i.e., lasting 〈 30 seconds). The occurrence of sustained VT was associated with a higher mortality rate than a nonoccurrence (OR, 2.04 and 95% confidence interval [CI], 1.23–3.39 for the 30-day mortality; OR, 4.06 and 95% CI, 2.04–8.08 for the 90-day mortality). The mortality risk did not differ between patients with non-sustained VT and nonoccurrence. A history of myocardial infarction, vasopressor use, and certain trends of blood laboratory findings (such as acidosis and hyperkalemia) were associated with the subsequent risk of sustained VT.Conclusion: Sustained VT occurrence after starting CRRT is associated with increased patient mortality. The monitoring of electrolytes and acid-base status during CRRT is essential because of its relationship with the risk of VT.

Type of Medium: Online Resource

ISSN: 2211-9140

URL: Article

DOI: 10.23876/j.krcp.22.101

Language: English

Publisher: The Korean Society of Nephrology

Publication Date: 2023

detail.hit.zdb_id: 2656420-8

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Mortality associated with the neutrophil-lymphocyte ratio in septic acute kidney injury requiring continuous renal replacement therapy

Lee, Jinwoo ; Song, Jeongin ; Kim, Seong Geun ; [et al.]

The Korean Society of Nephrology ; 2024

In: Kidney Research and Clinical Practice

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In: Kidney Research and Clinical Practice, The Korean Society of Nephrology

Type of Medium: Online Resource

ISSN: 2211-9140

URL: Article

DOI: 10.23876/j.krcp.23.116

Language: English

Publisher: The Korean Society of Nephrology

Publication Date: 2024

detail.hit.zdb_id: 2656420-8

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