Renal Replacement therapy in intensive care unit at a tertiary care center in Nepal

Abstract

Acute kidney injury is a major complication in intensive care unit patients. It is associated withincreased in-hospital mortality and length of stay. The provision of renal replacement therapy inintensive care is not widely available in resource poor countries like Nepal. The study aims to lookinto clinical profile and outcome of patients who received renal replacement therapy in intensive
care unit. It was an observational study done from 1st October 2016 till 30th September 2017.Patient’s demographic data, indications, biochemical tests, outcomes, modality of renal replacementtherapy were recorded. Statistical package for the social sciences version 17 was used for statisticalanalysis. There were total of 649 admissions in intensive care, among which 148 had kidney relatedcomplications. Of 148 patients, 69 (47%) received renal replacement therapy. Mean age, ureand creatinine on admission were 50.17 ± 18.42 years, 174.54 ± 63.46 mg/dl and 8.05 ± 3.49 mg/dl respectively. They underwent 4.32 ± 3.09 sessions and 14.94 ± 10.88 hours of renal replacementtherapy. Total 42 (61%) had septic shock on admission and underwent sustained low efficiency dialysisas the modality of renal replacement therapy. In-hospital mortality was 19 (28%). Presence of septicshock on admission and mean number of ionotropes required 2.05 ± 1.12 was statistically significantfor in-hospital mortality (p=0.01). About half of the patients were on mechanical ventilation whichwas statistically significant for in-hospital mortality (p<0.001). Sustained low efficiency dialysis canbe done in patients on ionotropes and patients can be switched over to intermittent hemodialysis.

Keywords : Intensive care unit, Nepal, renalreplacement therapy; sustainedlow efficiency dialysis