Inter-hospital transfers and outcomes of critically ill patients with severe acute kidney injury: a multicentre cohort study.
Crit Care. 2014 Sep 17;18(5):513
Authors: Kudlow P, Burns K, Adhikari N, Bell B, Klein DJ, Xie B, Friedrich JO, Wald R
IntroductionPatients with severe acute kidney injury (AKI) who are hospitalized at centres that do not provide renal replacement therapy (RRT) are frequently subjected to inter-hospital transfer for the provision of RRT. It is unclear whether such transfers are associated with worse patient outcomes as compared to the receipt of initial care in a centre that provides RRT. This study examined the relationship between inter-hospital transfer and 30-day mortality among critically ill patients with AKI who received RRT.MethodsWe conducted a retrospective cohort study of all critically ill patients who commenced RRT for AKI at two academic hospitals in Toronto, Canada. The exposure of interest was inter-hospital transfer for the administration of RRT. We evaluated the relationship between transfer status and 30-day mortality (primary outcome) and RRT dependence at 30 days following RRT initiation (secondary outcome) respectively, using multivariate logistic regression with adjustment for patient demographics, clinical factors, biochemical indices and severity of illness.ResultsOf 370 patients who underwent RRT for AKI, 82 (22.2%) were transferred for this purpose from another hospital. Compared to non-transferred patients who started RRT, transferred patients were younger (61¿±¿15 versus 65¿±¿15 years, P¿=¿0.03) and had a higher serum creatinine concentration at RRT initiation (474¿±¿295 versus 365¿±¿169 ¿mol/L, P¿=¿0.002). Inter-hospital transfer was not associated with mortality (adjusted OR 0.61, 95% CI 0.33 to 1.12) or RRT-dependence (adjusted OR 1.64, 95% CI 0.70 to 3.81) at 30 days.ConclusionsWithin the limitations of this observational study and the potential for residual confounding, inter-hospital transfer of critically ill patients with AKI was not associated with a higher risk of death or dialysis dependence 30 days after the initiation of acute RRT.
PMID: 25228166 [PubMed - as supplied by publisher]