Initial renal replacement therapy (RRT) modality associates with 90-day postdischarge RRT dependence in critically ill AKI survivors.

PURPOSE: Real-world comparison of RRT modality on RRT dependence at 90 days postdischarge among ICU patients discharged alive after RRT for acute kidney injury (AKI). METHODS: Using claims-linked to US hospital discharge data (Premier PINC AI Healthcare Database [PHD]), we compared continuous renal replacement therapy (CRRT) vs. intermittent hemodialysis (IHD) for AKI in adult ICU patients discharged alive from January 1, 2018 to June 30, 2021. RRT dependence at 90 days postdischarge was defined as ≥2 RRT treatments in the last 8 days. Between-group differences were balanced using inverse probability treatment weighting (IPTW). RESULTS: Of 34,804 patients, 3804 patients (from 382 hospitals) had claims coverage for days 83-90 postdischarge. Compared to IHD-treated patients (n = 2740), CRRT-treated patients (n = 1064) were younger; had more admission to large teaching hospitals, surgery, sepsis, shock, mechanical ventilation, but lower prevalence of comorbidities (p < 0.05 for all). Compared to IHD-treated patients, CRRT-treated patients had lower RRT dependence at hospital discharge (26.5% vs. 29.8%, p = 0.04) and lower RRT dependence at 90 days postdischarge (4.9% vs. 7.4% p = 0.006) with weighted adjusted OR (95% CI): 0.68 (0.47-0.97), p = 0.03. Results persisted in sensitivity analyses including patients who died during days 1-90 postdischarge (n = 112) or excluding patients from hospitals with IHD patients only (n = 335), or when excluding patients who switched RRT modalities (n = 451). CONCLUSIONS: Adjusted for potential confounders, the odds of RRT dependence at 90 days postdischarge among survivors of RRT for AKI was 30% lower for those treated first with CRRT vs. IHD, overall and in several sensitivity analyses. SUMMARY: Critically ill patients in intensive care units (ICU) may develop acute kidney injury (AKI) that requires renal replacement therapy (RRT) to temporarily replace the injured kidney function of cleaning the blood. Two main types of RRT in the ICU are called continuous renal replacement therapy (CRRT), which is performed almost continuously, i.e., for >18 h per day, and intermittent hemodialysis (IHD), which is a more rapid RRT that is usually completed in a little bit over 6 h, several times per week. The slower CRRT may be gentler on the kidneys and is more likely to be used in the sickest patients, who may not be able to tolerate IHD. We conducted a data-analysis study to evaluate whether long-term effects on kidney function (assessed by ongoing need for RRT, i.e., RRT dependence) differ depending on use of CRRT vs. IHD. In a very large US linked hospital-discharge/claims database we found that among ICU patients discharge alive after RRT for AKI, fewer CRRT-treated patients had RRT dependence at hospital discharge (26.5% vs. 29.8%, p = 0.04) and at 90 days after discharge (4.9% vs. 7.4% p = 0.006). In adjusted models, RRT dependence at 90 days postdischarge was >30% lower for CRRT than IHD-treated patients. These results from a non-randomized study suggest that among survivors of RRT for AKI, CRRT may result in less RRT dependence 90 days after hospital discharge.

Effects of a minimum interval immunization schedule for diphtheria and tetanus toxoids and acellular pertussis vaccination during a pertussis outbreak.

OBJECTIVE: To examine the impact of a minimum interval schedule for administering diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) in infants during a statewide pertussis outbreak on receipt of inactivated polio vaccine (IPV) and pneumococcal conjugate vaccine (PCV). DESIGN: Retrospective cohort study using the state immunization registry. SETTING: Arizona. PARTICIPANTS: Arizona children born between February 1 and September 30, 2005, who received their initial DTaP dose during a statewide pertussis outbreak (N = 45 129). Main Exposures Children who received at least 1 dose of DTaP on the minimum interval schedule (minimum interval group) compared with children who received all doses of DTaP on the standard childhood and adolescent immunization schedule (standard group). OUTCOME MEASURES: Timing and receipt of 3 doses of the DTaP, IPV, and PCV. RESULTS: Compared with children in the standard group, children in the minimum interval group were more likely to receive 3 doses of DTaP (relative risk, 1.34; 95% confidence interval, 1.32-1.35), 3 doses of IPV (1.27; 1.25-1.29), and 3 doses of PCV (1.37; 1.35-1.39). CONCLUSION: Recommending a minimum interval DTaP schedule during a statewide pertussis outbreak had a positive association with the receipt of IPV and PCV, 2 vaccines normally administered at the same time as DTaP.