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- Title
Renal Replacement Therapy in Patients With Stage IV Cancer Admitted to the Intensive Care Unit With Acute Kidney Injury at a Comprehensive Cancer Center Was Not Associated With Survival.
- Authors
Abudayyeh, Ala; Song, Juhee; Abdelrahim, Maen; Dahbour, Ibrahim; Page, Valda D.; Zhou, Shouhao; Shen, Chan; Zhao, Bo; Pai, Rima N.; Amaram-Davila, Jaya; Manzano, Joanna-Grace; George, Marina C.; Yennu, Sriram; Mandayam, Sreedhar A.; Nates, Joseph L.; Moss, Alvin H.
- Abstract
Introduction: In patients with advanced cancer, prolongation of life with treatment often incurs substantial emotional and financial expense. Among hospitalized patients with cancer since acute kidney injury (AKI) is known to be associated with much higher odds for hospital mortality, we investigated whether renal replacement therapy (RRT) use in the intensive care unit (ICU) was a significant independent predictor of worse outcomes. Methods: We retrospectively reviewed patients admitted in 2005 to 2014 who were diagnosed with stage IV solid tumors, had AKI, and a nephrology consult. The main outcomes were survival times from the landmark time points, inpatient mortality, and longer term survival after hospital discharge. Logistic regression and Cox proportional regression were used to compare inpatient mortality and longer term survival between RRT and non-RRT groups. Propensity score-matched landmark survival analyses were performed with 2 landmark time points chosen at day 2 and at day 7 from ICU admission. Results: Of the 465 patients with stage IV cancer admitted to the ICU with AKI, 176 needed RRT. In the multivariate logistic regression model after adjusting for baseline serum albumin and baseline maximum Sequential Organ Failure Assessment (SOFA), the patients who received RRT were not significantly different from non-RRT patients in inpatient mortality (odds ratio: 1.004 [95% confidence interval: 0.598-1.684], P =.9892). In total, 189 patients were evaluated for the impact of RRT on long-term survival and concluded that RRT was not significantly associated with long-term survival after discharge for patients who discharged alive. Landmark analyses at day 2 and day 7 confirmed the same findings. Conclusions: Our study found that receiving RRT in the ICU was not significantly associated with inpatient mortality, survival times from the landmark time points, and long-term survival after discharge for patients with stage IV cancer with AKI.
- Subjects
UNITED States; ACUTE kidney failure; CANCER patients; CANCER treatment; CONFIDENCE intervals; DECISION making; INTENSIVE care units; KIDNEY diseases; MULTIVARIATE analysis; PALLIATIVE treatment; QUESTIONNAIRES; RESEARCH funding; SURVIVAL analysis (Biometry); SURVIVAL; THERAPEUTICS; TUMOR classification; MULTIPLE regression analysis; SPECIALTY hospitals; ALBUMINS; PROPORTIONAL hazards models; RETROSPECTIVE studies; DATA analysis software; DESCRIPTIVE statistics; HOSPITAL mortality; KAPLAN-Meier estimator; ODDS ratio
- Publication
American Journal of Hospice & Palliative Medicine, 2020, Vol 37, Issue 9, p707
- ISSN
1049-9091
- Publication type
Article
- DOI
10.1177/1049909120902115