Outcomes of Patients Undergoing Renal Replacement Therapy in ICU in a Tertiary Level Teaching Hospital in Nepal- A Registry Based Retrospective Study.

Abstract

Background and aims: Requirement of renal replacement therapy (RRT) is associated with adverse clinical outcomes in intensive care unit (ICU). However, most of the studies have not included data from low- and middle- income countries (LMICs). This study aims to compare the characteristic and outcomes of patients undergoing RRT with those not requiring RRT (NRRT) in ICU.

Methods: This is a registry based retrospective cohort study of patients requiring RRT in a tertiary level university hospital in Nepal. We compared patients requiring RRT with those not requiring RRT for outcomes including ICU mortality, Length of stay in ICU (LOS-ICU) and duration of mechanical ventilation (MV). Odds ratio (OR) was calculated for between group comparison.

Results: Of the 3,733 patients admitted during the period of 3 years (January 1, 2020 to December 31, 2022), 516 (13.82%) underwent RRT. When compared with NRRT group, acute physiology and chronic health evaluation (APACHE) II scores, requirement of MV and non-invasive ventilation (NIV) were higher in RRT group. Also, RRT group had higher ICU mortality (OR 3.00, 95% CI 2.42-3.70, p<0.05), more prolonged LOS- ICU and a longer duration of MV (both with median of 5 days compared to 3 days; p<0.05). Directives for treatment limitations were more likely in the RRT group (OR 1.55, 95% CI 1.21-1.99, p<0.05) when compared with NRRT group.

Conclusion: Patients who require RRT in ICU have poor outcomes in terms of duration of MV, LOS-ICU and ICU mortality.