Vol.:(0123456789) 1 3 Journal of Nephrology https://doi.org/10.1007/s40620-020-00760-x ORIGINAL ARTICLE Impact of the intensity of intermittent renal replacement therapy in critically ill patients Alicia Molina‑Andújar 1  · Pau Alcubilla 2  · Pedro Santiago 3  · Miquel Blasco 1  · David Cucchiari 1  · Gaston Piñeiro 1  · Rut Andrea 4  · Sara Fernández 5  · Enric Reverter 6  · Jordi Mercadal 7  · Eduard Quintana 8  · Esteban Poch 1,9  on behalf of the Hospital Clínic Intensive Care Working Group (GMTC) Received: 6 March 2020 / Accepted: 23 May 2020 © Italian Society of Nephrology 2020 Abstract Background Intermittent renal replacement therapy (IRRT) is prescribed across intensive care units (ICU) worldwide. While research regarding the prescribed dialysis dose has not yielded results concerning mortality, it is still unknown whether the same applies to the actual delivered dose. Methods We retrospectively analyzed two diferent cohorts of patients (562 IRRT sessions) who were admitted to the inten- sive care units at Hospital Clínic of Barcelona and required renal replacement therapy with IRRT. The frst cohort included patients with acute kidney injury (AKI) (n = 42) and the second included patients already on chronic hemodialysis (CKD 5D) (n = 47). Only patients who had at least 3 recorded hemodialysis sessions in the ICU and with no previous continuous renal replacement therapy (CRRT) were included. The achieved dose was measured as Kt (L) by ionic dialysance and the primary endpoint was 90-day mortality. Results Ninety-day mortality was 40.5% (n = 17) in the AKI cohort and 23.9% (n = 11) in the CKD 5D cohort with mean Kt of 43 ± 8.27 L and 47 ± 9.65 L respectively. Kt dose of IRRT was associated with 90-day mortality in the AKI cohort in a multivariate surveillance analysis adjusted for confounding factors (HR 0.935 [0.88–0.99], p = 0.02). Only the Kt dose and age remained statistically associated with the outcome in the AKI cohort. Conclusions Delivered dialysis dose as measured by ionic-dialysance Kt may be associated with survival in critically-ill patients with AKI, while it does not seem to afect outcomes in critically-ill CKD 5D patients. This exploratory analysis will need confrmation in larger prospective studies. Keywords Intermittent renal replacement therapy · Dialysis dose · Acute kidney injury · Intensive care unit · Ionic dialysance · Kt Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40620-020-00760-x) contains supplementary material, which is available to authorized users. * Esteban Poch epoch@clinic.cat 1 Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain 2 Clinical Pharmacology Department, Hospital Clínic, Barcelona, Spain 3 University of Barcelona, Barcelona, Spain 4 Acute Cardiac Care Unit, Cardiology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain 5 Intensive Care Unit, Internal Medicine Department, Hospital Clínic, University of Barcelona, Barcelona, Spain 6 Intensive Care Unit, Hepatology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain 7 Surgical Intensive Care Unit, Anesthesiology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain 8 Cardiovascular Intensive Care Unit, Cardiovascular-Surgery Department, Hospital Clínic, University of Barcelona, Barcelona, Spain 9 Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain