P0591AKI TREATMENT WITH CVVH IN THE ICU: A FIFTEEN MONTH SINGLE-CENTER EXPERIENCE
Authors: Lucca Bernardo , Perletti Silvia , Mortari Gabriele , Gaggia Paola , Zubani Roberto , Manenti Chiara , Movilli Ezio , Scolari Francesco 
Published: June 2020

Abstract

Background and Aims
AKI (Acute Kidney Injury) is a condition associated with elevated morbility and mortality. It determines prolonged hospitalization and severe long-term complications. AKI often complicates the course of patients’ stay in ICU (Intensive Care Units) sometimes requiring CRRT (Continuous Renal Replacement Therapy). Our aim was to prospectively analyze and report our experience on CRRT carried out in our hospital’s ICUs, and to compare it with guideline recommendations and with other international experiences.

Method
This is a single-center prospective observational study. We collected epidemiologic, clinical and technical data regarding all CRRT treatments performed in the four ICUs (two general ICUs and two cardiological ICUs) at the ASST Spedali Civili of Brescia Italy, between 02/01/2018 and 05/31/2019. AKI was defined according to KDIGO guidelines. Exclusion criteria were: age less than 16 years, chronic dialysis treatment, functioning kidney transplantation. All CRRT were provided in the CVVH (Continuous Veno-Venous Hemofiltration) mode.

Results
We included 146 incident patients (M: 103; 70%), mean age 71 ± 15 years. Most treatments were performed in the cardiological ICUs (58%) as opposed to the general ICUs (42%). AKI was present at the moment of admission to the ICU in 67% of patients. 53% of patients had previous CKD. The most frequent comorbidities were: hypertension (73%), diabetes (45%), ischemic heart disease (38%). The most frequent reasons for starting CVVH were: severe oliguria (88%) and fluid overload (68%). 57% of patients had stage 3 AKI. At the time of treatment initiation 55% of patients also had congestive heart failure, 52% metabolic acidosis, and 51% sepsis. 23% were recovering from heart surgery and 10% from general surgery. Mechanic ventilation was performed in 40% of patients, non-invasive ventilation in 28%. 82% of patients required vasoactive treatment. The average SOFA score was 10 ± 2,9. Technical details of CVVH prescription are reported in Fig 1. The most common vascular access was a dual lumen femoral vein catheter in 96% of cases. Citrate anticoagulation was used in 32% of treatments, heparin in 27%. Circuit coagulation was the most frequent cause for set substitution (45%). Treatments using citrate had fewer set coagulations compared to heparin (18% vs 32%). The average dialysis dose was 31,2 ml/kg/h. Median treatment duration was 7,6 days, median stay in the ICU was 14,3 days, median global hospitalization lasted 30,9 days. Mortality rate was 47% in the ICU and 64% 90 days after discharge. The most frequent causes of death were MOF (33%), septic shock (20%) and cardiogenic shock (14%). As illustrated in figure 2, multivariate analysis showed that mortality was negatively influenced by the presence of liver cirrhosis, septic shock, cardiogenic shock and rhabdomyolysis. After hospital discharge, 14 patients continued to require chronic dialysis.

Conclusion
Our experience shows that in patients with AKI requiring CVVH, mortality rate is negatively influenced by the presence of septic and cardiogenic shock, liver cirrhosis and rhabdomyolysis. Treatment prescription respected clinical and technical guideline recommendations, and is mostly comparable to the related international literature.