Outcomes of dialysis patients with end-stage renal disease needing intensive care unit admission

Sivagnanavel Senthuran,1 Hiran Bandeshe,1 Dwarakanatha Ranganathan,2,3 Rob Boots 1

1 Department of Intensive Care Medicine, Royal Brisbane Hospital, Brisbane, QLD

2 Department of Renal Medicine, Royal Brisbane Hospital, Brisbane, QLD

3 Australia and New Zealand Dialysis and Transplant Registry(ANZDATA), Adelaide, SA

Introduction

Dialysis patients often have multiple comorbidities, and there are limited data on prognostic indicators. There is only one previous Australian study — of 38 dialysis patients receiving continuous renal replacement — which noted an 18% ICU mortality and 38% hospital mortality.

Aim

• To identify features of survivors and non-survivors among dialysis patients admitted to the ICU;
• To characterise the pattern of recurrent admissions
• To calculate median survival following discharge from hospital after ICU admission;and
• To estimate our ICU and hospital mortality for dialysis patients.

Setting and methods

We conducted a retrospective study using prospectively collected data from local and national databases on 70 dialysis patients admitted to the ICU over 5 years between 2001 and 2006 at a single tertiary referral hospital in Queensland,Australia.

Results

Dialysis patients had an ICU mortality of 17% and a hospital mortality of 28%. The 12 deaths in the ICU occurred a median of 18 hours after admission, reflecting the severity of the patients’ underlying illness. The independent predictors of hospital death were age and number of non-renal organ systems failing. Patients with pulmonary oedema had a low risk of death. Although 21 patients accounted for 55 of a total of 104 admissions, the recurrent admissions generally occurred during different hospital episodes and were not associated with a higher risk of hospital death.Admission serum calcium, phosphorus, albumin or urate concentrations did not differentiate survivors from nonsurvivors. Patients discharged home after an ICU stay had a median survival of 2.25 years from hospital discharge or 3.5 years from starting dialysis. In comparison, the median survival on dialysis for patients in Australia in general is 4.52 years (Australia and New Zealand Dialysis and Transplant Registry).

Conclusions

Age and number of non-renal organ failures were independent predictors of hospital death. Recurrent ICU admissions were not associated with increased risk of hospital death. Our study suggests dialysis patients discharged home after an ICU admission have an acceptable survival. A large multicentre prospective study is required to better characterise prognostic features.