Long-term outcomes of end-stage renal disease patients admitted to the ICU

Abstract

Background. End-stage renal disease (ESRD) patients ad-mitted to the intensive care unit (ICU) have poor survival and high rates of readmission; however, little evidence exists on long-term outcomes. We set out to investigate the long-term (6 and 12 months) survival of ESRD patients admitted to the ICU and whether differential survival could be ex-plained by dialysis modality and vascular access. Methods. We compared the admission characteristics, out-comes and readmission rates of 619 ESRD [95 peritoneal dialysis (PD), 334 hemodialysis with a catheter (HD CVC), 190 hemodialysis with an AV fistula (HD AVF)] patients admitted to 11 ICU’s in Winnipeg, Manitoba, Canada. Parametric and nonparametric tests were used as appropri-ate to determine differences in baseline characteristics. Multivariable Cox and logistic regression was used to assess outcomes between the groups. Results. The 6- and 12-month crude survival was 62 and 52%, respectively. In a univariate model, modality and vascular access were associated with an increased hazard ratio (HR) of death [PD HR 1.60 95 % confidence interval (CI) 1.20–2.13, HD CVC HR 1.55 95 % CI 1.25–1.93] compared to patients on HD with an AVF. In three differ-ent multivariate adjusted models, this association per-sisted with HRs for death of 1.63–1.75 for PD and 1.50–1.58 for HD CVC. Conclusions. Overall long-term survival of ESRD patients after admission to the ICU is poor. Being on PD or bein