A Novel Nonparametric Test for Heterogeneity Detection and Assessment of Fluid Removal Among CRRT Patients in ICU

Over the past decade acute kidney injury (AKI) has been occurring among 20%-50% of patients admitted to the intensive care unit (ICU) in United States. Continuous renal replacement therapy (CRRT) has become a popular treatment method among these critically ill patients. But there are multiple complications in implementing this treatment, including discrepancies in practiced and prescribed fluid removal, possibly related to the heterogeneity among these patients. With mixture modeling there have been several techniques in detecting heterogeneity with their specific limitations. In this dissertation a novel nonparametric ‘d test’ will be used to detect heterogeneity among CRRT patients in ICU. Along with heterogeneity detection, this dissertation will also seek to understand ongoing issues with fluid removal and discrepancy in treatment implementations

Prognostic significance of acute kidney injury stage 1B in hospitalized patients with cirrhosis: A US nationwide study

Background: Understanding the prognostic significance of acute kidney injury (AKI) stage-1B [serum creatinine (sCr) > 1.5 mg/dL], compared to stage-1A (sCr 1.5-2-fold increase in sCr from baseline) and were followed for 90-days for outcomes. Primary outcome was 90-day mortality; secondary outcomes were in hospital AKI progression and AKI recovery. Competing-risk multivariable analysis was performed to determine the independent association between stage-1B, 90-day mortality (liver transplant as competing-risk) and AKI recovery (death/liver-transplant as competing-risk). Multivariable logistic regression analysis was performed to determine the independent association between stage-1B and AKI progression. Results: 4,654 patients with stage 1 were analyzed: 1A (44.3%) and 1B (55.7%). Stage-1B patients had significantly higher cumulative incidence of 90-day mortality compared to stage-1A patients, 27.2% vs. 19.7% (p < 0.001). On multivariable competing-risk analysis, patients with stage 1B (vs. 1A) had higher risk for mortality at 90-days [sHR 1.52 (95%CI 1.20-1.92), p = 0.001] and decreased probability for AKI recovery [sHR 0.76 (95%CI 0.69-0.83), p < 0.001]. Furthermore, on multivariable logistic regression analysis, AKI stage-1B (vs. 1A) was independently associated with AKI progression, OR 1.42 (95%CI 1.14-1.72) (p < 0.001). Conclusions: AKI stage-1B patients have significantly higher risk for 90-day mortality, AKI-progression, and reduced probability of AKI-recovery compared to AKI stage-1A patients. These results could guide initial management decisions for AKI in hospitalized patients with cirrhosis

Epidemiology and Outcomes of AKI Treated With Continuous Kidney Replacement Therapy: The Multicenter CRRTnet StudyPlain Language Summary

Rationale &amp; Objective: Continuous kidney replacement therapy (CKRT) is the predominant form of acute kidney replacement therapy used for critically ill adult patients with acute kidney injury (AKI). Given the variability in CKRT practice, a contemporary understanding of its epidemiology is necessary to improve care delivery. Study Design: Multicenter, prospective living registry. Setting &amp; Population: 1,106 critically ill adults with AKI requiring CKRT from December 2013 to January 2021 across 5 academic centers and 6 intensive care units. Patients with pre-existing kidney failure and those with coronavirus 2 infection were excluded. Exposure: CKRT for more than 24 hours. Outcomes: Hospital mortality, kidney recovery, and health care resource utilization. Analytical Approach: Data were collected according to preselected timepoints at intensive care unit admission and CKRT initiation and analyzed descriptively. Results: Patients’ characteristics, contributors to AKI, and CKRT indications differed among centers. Mean (standard deviation) age was 59.3 (13.9) years, 39.7% of patients were women, and median [IQR] APACHE-II (acute physiologic assessment and chronic health evaluation) score was 30 [25-34]. Overall, 41.1% of patients survived to hospital discharge. Patients that died were older (mean age 61 vs. 56.8, P < 0.001), had greater comorbidity (median Charlson score 3 [1-4] vs. 2 [1-3], P < 0.001), and higher acuity of illness (median APACHE-II score 30 [25-35] vs. 29 [24-33], P = 0.003). The most common condition predisposing to AKI was sepsis (42.6%), and the most common CKRT indications were oliguria/anuria (56.2%) and fluid overload (53.9%). Standardized mortality ratios were similar among centers. Limitations: The generalizability of these results to CKRT practices in nonacademic centers or low-and middle-income countries is limited. Conclusions: In this registry, sepsis was the major contributor to AKI and fluid management was collectively the most common CKRT indication. Significant heterogeneity in patient- and CKRT-specific characteristics was found in current practice. These data highlight the need for establishing benchmarks of CKRT delivery, performance, and patient outcomes. Data from this registry could assist with the design of such studies