Introduction: Continuous renal replacement therapy (CRRT) is typically favored over tent hemodialysis (IHD) in hemodynamically unstable critically ill patients. Its comparative effectiveness in critically ill cancer patients with acute kidney injury (AKI), however, remains uncertain. We aimed to emulate a randomized trial using real-world data to compare CRRT and IHD in critically ill cancer patients. Methods: This retrospective cohort study was conducted using the TriNetX Global Collaborative Network. Adult patients (18 - 80 years) with active malignancy and AKI, without prior advanced chronic kidney disease, who underwent either CRRT or IHD, were included. After 1:1 propensity score matching, 660 patients remained in each group. The primary outcome was 90-day all-cause mortality. Secondary outcomes included new-onset advanced CKD and duration of mechanical ventilation. Outcomes were assessed using risk ratios (RR), hazard ratios (HR), and Kaplan-Meier survival analysis. Results: CRRT was associated with higher 90-day mortality compared to IHD (55.5% vs. 42.4%; RR 1.31, 95% CI 1.17–1.47; HR 1.52, 95% CI 1.30–1.78; p < 0.001). In contrast, CRRT was associated with a lower incidence of progression to advanced CKD (2.0% vs. 9.3%; RR 0.22, 95% CI 0.12–0.40; HR 0.22, 95% CI 0.11–0.40; p < 0.001). No significant differences were observed in the need for mechanical ventilation. Conclusions: In this emulated trial using real-world data, CRRT was associated with increased short-term mortality but reduced risk of progression to advanced CKD when compared to IHD in critically ill cancer patients with AKI. These findings highlight the need for prospective trials to determine optimal renal replacement strategies in this population.
Papp et al. (Sun,) studied this question.