Incidence and Predictors of Acute Kidney Injury and Continuous Renal Replacement Therapy in Critically Ill Trauma Patients: A 10-Year Retrospective Analysis.

Abstract

Background: Acute Kidney Injury (AKI) is common in critically ill trauma patients and is associated with increased morbidity and mortality. A subset of these patients requires Continuous Renal Replacement Therapy (CRRT) for severe AKI. This study investigates the incidence of AKI and CRRT and identifies predictors for AKI progression in trauma patients.

Methods: We conducted a 10-year retrospective review of trauma ICU patients at a Level I trauma center from 2014 to 2023. Patients were classified into three groups: no AKI, AKI without CRRT, and AKI requiring CRRT. Statistical analyses, including logistic regression and Kaplan-Meier survival estimates, were used to assess risk factors and survival. Variables analyzed included age, injury severity score (ISS), admission hemodynamics, and procedural interventions.

Results: Of 8427 patients, 5.5% developed AKI, and 1% required CRRT. AKI patients showed decreased survival (83% vs. 88%, p = 0.003). Survival was lower in CRRT compared to AKI only (73% v 83%, p < 0.001). Older age (OR 1.01, 95% CI 1.003, 1.012, p < 0.001), ISS (OR 1.02, 95% CI 1.01, 1.02, p < 0.001), and lower systolic blood pressure on admission (OR 0.98, 95% CI 0.98, 0.99, p < 0.001) were predictive of AKI. In AKI, tachycardia on admission was predictive of CRRT need (OR 1.01, 95% CI 1.01, 1.03, p = 0.04). The most common procedure with AKI was laparotomy (n = 42) with 40% requiring CRRT.

Conclusions: AKI and CRRT are associated with mortality in trauma. Identifying predictors like age, injury severity, and hemodynamic changes can aid in early intervention. Further research should explore the timing and impact of CRRT in trauma-specific settings.