대한신장학회

논문분류	춘계학술대회 초록집
제목	Major adverse cardiovascular events and clinical outcomes in intensive care unit patients with acute renal replacement therapy
저자	Sehoon Park1, Soojin Lee1, Hyung Ah Jo2, Yerim Kim1, Jungnam Ahn3, Kwon Wook Joo1, Chun Soo Lim3, Yon Su Kim1, Hyeongsu Kim4, Dong Ki Kim1
출판정보	2018; 2018(1):
키워드	CRRT \| Intensive care unit \| Acute kidney injury \| dialysis
초록	Objectives: Risk of the major adverse cardiovascular event (MACE) in intensive care unit (ICU) patients who required acute renal replacement therapy (ARRT) needs further investigation. Methods: This study was a nationwide population-based study using the claim database of Korea. We reviewed the ICU patients in over forty government-designated tertiary hospitals in Korea from 2005 to 2016. The study group consisted of the patients who underwent ARRT, and the control group was ICU patients without ARRT. Patients who 1) had age under 20, 2) expired within 30 days after ICU care, 3) underwent ICU care less than 24 hours, 4) with a previous history of ICU admission, 5) MACE, or 6) known MACE related cardio- or cerebrovascular diseases were excluded. Within the study group, the outcome of CRRT patients was compared with the patients who received intermittent renal replacement therapy (IRRT) in the ICU. The primary outcome was the MACE, including acute myocardial infarction, revascularization, and acute ischemic stroke. Patient mortality and progression to end-stage renal disease were also evaluated. Results: We included 12,380 ARRT patients and 382,018 patients in the control group. Among the study group, 6,891 patients were categorized as the CRRT group, and 5,034 as the IRRT group, respectively. The risks of MACE [adjusted hazard ratio (HR) 1.292 (1.205-1.386), P<0.001], all-cause mortality [adjusted HR 1.343 (1.296-1.391), P<0.001], and end-stage renal disease [adjusted HR 10.752 (10.119-11.424), P<0.001] were increased in the ARRT patients. When we compared the CRRT to the IRRT patients, the risk of MACE was comparable [adjusted HR 1.105 (0.947-1.288), P=0.204]. Conclusions: The risk of adverse cardiovascular outcome was increased in patients who underwent ARRT. Clinicians may consider appropriate risk factor management for dialysis-requiring ICU survivors. Receiving CRRT was not associated with an elevated cardiovascular risk when compared to IRRT in ICU. Prognosis of patients according to dialysis modality
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