M. Choi1, N. K. Dhillon1, E. J. Smith1, J. M. Tatum1, G. Barmparas1, H. Rodriguez1, E. J. Ley1 1Cedars-Sinai Medical Center,Los Angeles, CA, USA
Introduction: Continuous renal replacement therapy (CRRT) is utilized primarily in patients with renal failure and hemodynamic instability. The role of CRRT in patients without renal failure who have malignant hypervolemia has not been studied.
Methods: A review of all patients receiving CRRT in the surgical intensive care unit from February 2013 to February 2015 was performed. Patients undergoing CRRT for hypervolemia without a prior diagnosis of chronic kidney injury and creatinine of 1.5 or less were identified. The group was analyzed for patient characteristics including diagnosis, ICU length of stay (LOS), hospital LOS, APACHE II scores, CRRT duration, volume removed with CRRT, and mortality.
Results: Fifty-nine patients underwent CRRT during the study period. Of the 59, 21 (35.6%) had undergone CRRT for hypervolemia without presence or history of renal failure. Mean age was 61.2 ± 15.2 years, 15 (71%) were male, and median APACHE II score was 28.5 (4.5-47.2). The median ICU and Hospital LOS were 16 (7.5-22) and 29.9 ± 14.2 days, respectively. Mean creatinine prior to the initiation of CRRT in the study population was 1.1 ± 0.3. Patients underwent CRRT for a median of 6 (4-13) days with a total median volume of 15.9 (9.6-3.8) liters removed. A mean of 2.8 ± 1.1 liters was removed per day. The mortality rate for this group was 33%.
Conclusion: CRRT can be utilized to remove volume from critically ill patients with malignant hypervolemia in the setting of normal renal function. Further investigation is warranted on how to best use this therapy for patients without renal failure.