Outcomes Associated With Renal Replacement Therapy Use and Modality in Cardiogenic Shock Patients

Background Renal replacement therapy (RRT) is frequently employed to treat severe acute kidney injury (AKI), which can occur in the setting of cardiogenic shock (CS). The outcomes associated with the utilization and modality of RRT—namely, intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT)—in patients with CS remain poorly understood. Methods We included adult cardiac intensive care unit (CICU) patients with CS from 2007 to 2018 and compared outcomes based on the utilization and modality of RRT (IHD or CRRT). The primary outcome of in-hospital mortality was analyzed using logistic regression. The secondary outcome of 1-year mortality was analyzed using Cox regression. Regression models were adjusted for known mortality predictors. Results Out of 1498 patients with a CS diagnosis, 204 (13.6%) patients received RRT, of which 147 (77.0%) received CRRT. RRT patients were sicker, especially those who received CRRT, who had the highest severity of illness. A total of 499 (33.3%) patients died in hospital. RRT patients had higher in-hospital mortality (48.0% vs. 31.0%, adjusted odds ratio [OR] 2.04, 95% confidence interval [CI] 1.43–2.92, P < .001) and higher 1-year mortality, particularly among hospital survivors (adjusted hazard ratio [HR] 1.80, 95% CI 1.19–2.72, P = .005). In-hospital mortality (55.8% vs. 28.2%, adjusted OR 2.70, 95% CI 1.79–4.07, P < .001) and 1-year mortality were higher for patients who received CRRT compared with IHD. Overall 1-year survival was 33% for patients who received RRT. Conclusion The need for RRT is associated with higher short- and intermediate-term mortality in patients with CS. Patients requiring CRRT have an incrementally higher risk compared with those who receive IHD.