Association of hospital-level continuous kidney replacement therapy use and mortality in critically ill patients with acute kidney injury

Abstract

Purpose: In numerous high-risk medical and surgical conditions, an increased volume of patients and procedures is associated with improved processes and survival. This study examined the association of hospital-level continuous kidney replacement therapy (CKRT) utilization rates with all-cause hospital mortality in critically ill patients with acute kidney injury (AKI). Methods: This multicenter cohort study used data from patients admitted to the intensive care unit (ICU) within the Premier Incorporated AI (PINC-AI) database. Patients were critically ill adults with AKI receiving kidney replacement therapy (KRT) in U.S. hospitals that offered both CKRT and intermittent hemodialysis. Hospitals were characterized according to their CKRT utilization in the ICU, and risk-adjusted association with all-cause hospital mortality by day 90 was estimated. Results: Among 49,685 patients with AKI admitted to 426 acute care U.S. hospitals and treated with KRT in the ICU, a higher hospital-level CKRT utilization rate was associated with lower patient-level risk-adjusted hospital mortality. Hospitals with higher CKRT utilization rates (CKRT use in ≥ 31.5% of KRT patients per year) had a 15% lower adjusted probability of death compared with hospitals with lower CKRT utilization rates (CKRT use in < 8% of KRT patients per year). When compared with the first quartile of hospital-level CKRT use, the third (adjusted hazard ratio [aHR], 0.93, 95%CI: 0.89–0.98) and fourth (aHR, 0.85, 95%CI: 0.81–0.89) quartiles were associated with lower risk-adjusted hospital mortality. Findings were consistent in several sensitivity analyses. Conclusions: Among critically ill adults with AKI requiring KRT, treatment in hospitals with higher CKRT utilization rates was associated with reduced hospital mortality.