CONTINUOUS KIDNEY REPLACEMENT THERAPY IN CRITICALLY ILL INTENSIVE CARE UNIT PATIENTS WITH ACUTE KIDNEY INJURY IN A DISTRICT HOSPITAL WITHOUT NEPHROLOGIST

Abstract

Introduction - Acute kidney injury in critically ill patient is associated with increased mortality. This paper describes characteristics of intensive care unit (ICU) patients who required continuous kidney replacement therapy (CKRT), property of CKRT, and clincal outcomes.

Method - Retrospective descriptive review was conducted on 13 patients diagnosed with sepsis and underwent CKRT in an ICU of a district hospital without a in-house nephrologist between May 2022 to March 2023. Treatment indications were refractory fluid overload, severe metabolic acidosis, hyperkalaemia, and symptomatic uraemia. We describe patients’ characteristics, disease severity with Sequential Organ Failure Assessment (SOFA) score, nephrology referral and CKRT initiation, characteristics of CKRT, and outcomes i.e. length of ICU stay, mortality and renal recovery.

Results - There were 13 critically ill patients diagnosed with sepsis and underwent CKRT in ICU since May 2022. There were five males and eight females, mean age 46 years (SD13.6). Pre-morbidly, eight had diabetes mellitus (61.5%), six had hypertension (46%), and three had heart failure (23%). Twelve patients (92%) had severe disease; mean SOFA score 16 (SD3.2). Time to nephrology referral were <1-2 days, with treatments initiation within 2 hours. Mean treatment duration is 38 hours (SD31.8). Incomplete treatment is due to seven circuit clotting and four deaths. Mean length of ICU stay was 10 days. Three patients survived with renal recovery. Mortality rate was 77%.

Conclusion - CKRT provides hemodynamic stability for critically ill patients. We aim to improve outcomes by expanding treatment availability. This review provides improvement direction and encourages CKRT initiation.