A55-33 In-Hospital Outcomes of Acute Respiratory Distress Syndrome Patients Requiring Continuous Renal Replacement Therapy: A Nationwide Analysis (2016-2021)

Rationale Acute respiratory distress syndrome (ARDS) is a life-threatening condition that can be complicated by acute kidney injury requiring continuous renal replacement therapy (CRRT), reflecting severe multi-organ dysfunction. The outcomes of this subgroup remain poorly characterized. This study evaluated in-hospital outcomes among adults with ARDS who received CRRT. Methods Hospitalizations from the Nationwide Inpatient Sample (2016-2021) were analyzed to identify adults (≥18 years) with ARDS using ICD-10 codes. Patients with end-stage renal disease were excluded. The study group comprised those receiving CRRT; the control group included ARDS patients without CRRT. The primary outcome was in-hospital mortality. Secondary outcomes included mechanical ventilation, vasopressor use, sepsis, tracheostomy, length of stay, discharge disposition, and hospitalization cost. Multivariable logistic regression adjusted for demographic and clinical confounders. Results A total of 485,035 ARDS hospitalizations were identified, of which 26,995 (5.6%) received CRRT. Compared with non-CRRT patients, they were younger (58.4 vs 60.6 years, P < 0.0001), less often female (34.5% vs. 44.0% female, P < 0.0001), and had a different racial distribution (White 50.0% vs 58.0%; African American 21.0% vs 14.0%; P < 0.0001). After adjustment for confounders, CRRT use was associated with significantly higher in-hospital mortality (adjusted OR 3.3; 95% CI 3.06-3.55; P < 0.0001) and greater odds of mechanical ventilation (6.63; 5.69-7.73), vasopressor use (2.23; 2.10-2.37), sepsis (2.67; 2.45-2.91), and tracheostomy (1.66; 1.53-1.80), all P < 0.0001. CRRT recipients had longer hospital stays (23 vs 17 days; P < 0.0001), higher total charges ($557,424 vs $295,426; P < 0.0001), and lower home-discharge rates (2.7% vs 18.9%; P < 0.0001). Conclusion CRRT in ARDS is associated with nearly threefold higher mortality, prolonged hospitalization, greater complication burden, and markedly higher cost, reflecting advanced multi-organ failure. These findings underscore the need for early renal protection and integrated critical care management strategies. This abstract is funded by: None