Patients with end-stage renal disease (ESRD) experience higher rates of hospitalisation, cardiovascular events, and all-cause mortality and are more likely to require admission to the intensive care unit (ICU) than patients with normal renal function. Sepsis and cardiovascular diseases are the most common reasons for ICU admission. ICU mortality rates in patients requiring chronic hemodialysis are significantly higher than for patients without ESRD; however, dialysis patients have a better ICU outcome than those with acute kidney injury (AKI) requiring renal replacement therapy suggesting that factors other than loss of renal function contribute to their prognosis. Current evidence suggests, the longer-term outcomes after discharge from ICU may be favourable and that long-term dependence on dialysis should not prejudice against prompt referral or admission to ICU. 1. Introduction The incidence and prevalence of end-stage renal disease (ESRD) is rising worldwide, in part, due to the increasing rates of diabetes, hypertension, and an ageing population [1, 2]. ESRD patients experience higher rates of hospitalisation, cardiovascular events, and all-cause mortality when compared to patients with normal renal function, and are more likely to require admission to the intensive care unit (ICU) [3, 4]. It is estimated that 2% of chronic dialysis patients require admission to ICU every year [5]. The presence of established end-stage organ failure and often numerous comorbidities can impact on decisions regarding escalation of care and ICU admission. It was previously assumed that patients requiring long-term dialysis would have similar ICU outcomes to those with acute kidney injury (AKI) requiring acute RRT; however, emerging evidence suggests otherwise. 2. Admission Rates to ICU Chronic dialysis patients have significantly higher critical care admission rates than the general population, with a calculated 15.6 admissions per 100 prevalent patients with ESRD per year versus 0.58 per 100 prevalent patients without ESRD per year [6]. The largest cohort of critically ill ESRD patients studied derives from the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme Database which records patient data from more than 200 ICUs across the UK. Analysis of this database showed that from 1995 to 2004, there were 270,972 admissions to ICU, of whom 1.3% were chronic dialysis patients [4]. This was estimated to be equivalent to six ICU admissions or 32 ICU bed days per 100 dialysis patient-years. When compared to annual ICU admission rates of 2 per 1,000 of
References
[1]
UK Renal Registry 13th Annual Report, The Renal Association, December 2010.
[2]
A. J. Collins, R. N. Foley, C. Herzog, et al., “US renal data system 2010 annual data report,” American Journal of Kidney Diseases, vol. 57, no. 1, supplement 1, pp. A8–526.
[3]
A. S. Go, G. M. Chertow, D. Fan, C. E. McCulloch, and C. Y. Hsu, “Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization,” The New England Journal of Medicine, vol. 351, no. 13, pp. 1296–1370, 2004.
[4]
C. A. Hutchison, A. V. Crowe, P. E. Stevens, D. A. Harrison, and G. W. Lipkin, “Case mix, outcome and activity for patients admitted to intensive care units requiring chronic renal dialysis: a secondary analysis of the ICNARC Case Mix Programme Database,” Critical Care, vol. 11, article no. R50, 2007.
[5]
S. Uchino, H. Morimatsu, R. Bellomo, W. Silvester, and L. Cole, “End-stage renal failure patients requiring renal replacement therapy in the intensive care unit: incidence, clinical features, and outcome,” Blood Purification, vol. 21, no. 2, pp. 170–175, 2003.
[6]
B. Strijack, J. Mojica, M. Sood et al., “Outcomes of chronic dialysis patients admitted to the intensive care unit,” Journal of the American Society of Nephrology, vol. 20, no. 11, pp. 2441–2447, 2009.
[7]
G. Manhes, A. E. Heng, B. Aublet-Cuvelier, N. Gazuy, P. Deteix, and B. Souweine, “Clinical features and outcome of chronic dialysis patients admitted to an intensive care unit,” Nephrology Dialysis Transplantation, vol. 20, pp. 1127–1133, 2005.
[8]
G. Clermont, C. G. Acker, D. C. Angus, C. A. Sirio, M. R. Pinsky, and J. P. Johnson, “Renal failure in the ICU: comparison of the impact of acute renal failure and end-stage renal disease on ICU outcomes,” Kidney International, vol. 62, no. 3, pp. 986–996, 2002.
[9]
M. J. Sarnak and B. L. Jaber, “Mortality caused by sepsis in patients with end-stage renal disease compared with the general population,” Kidney International, vol. 58, no. 4, pp. 1758–1764, 2000.
[10]
S. I. Dara, B. Afessa, A. A. Bajwa, and R. C. Albright, “Outcome of patients with end-stage renal disease admitted to the intensive care unit,” Mayo Clinic Proceedings, vol. 79, no. 11, pp. 1385–1390, 2004.
[11]
S. Senthuran, H. Bandeshe, D. Ranganathan, and R. Boots, “Outcomes for dialysis patients with end-stage renal failure admitted to an intensive care unit or high dependency unit,” Medical Journal of Australia, vol. 188, no. 5, pp. 292–295, 2008.
[12]
M. Bell, F. Granath, S. Sch？n, E. L？fberg, A. Ekbom, and C. R. Martling, “End-stage renal disease patients on renal replacement therapy in the intensive care unit: short- and long-term outcome,” Critical Care Medicine, vol. 36, no. 10, pp. 2773–2778, 2008.
[13]
D. Juneja, M. V. Prabhu, P. B. Gopal, S. Mohan, G. Sridhar, and K. S. Nayak, “Outcome of patients with end stage renal disease admitted to an intensive care unit in India,” Renal Failure, vol. 32, no. 1, pp. 69–73, 2010.
[14]
E. Rocha, M. Soares, C. Valente et al., “Outcomes of critically ill patients with acute kidney injury and end-stage renal disease requiring renal replacement therapy: a case-control study,” Nephrology Dialysis Transplantation, vol. 24, no. 6, pp. 1925–1930, 2009.
[15]
M. M. Sood, L. Miller, P. Komenda et al., “Long-term outcomes of end-stage renal disease patients admitted to the ICU,” Nephrology Dialysis Transplantation, vol. 26, pp. 2965–2970, 2011.
[16]
C. A. Herzog, “Cardiac arrest in dialysis patients: approaches to alter an abysmal outcome,” Kidney International, Supplement, vol. 63, no. 84, pp. S197–S200, 2003.
[17]
W. A. Knaus, E. A. Draper, D. P. Wagner, and J. E. Zimmerman, “APACHE II: a severity of disease classification system,” Critical Care Medicine, vol. 13, no. 10, pp. 818–829, 1985.
[18]
R. J. Chapman, M. Templeton, S. Ashworth, R. Broomhead, A. McLean, and S. J. Brett, “Long-term survival of chronic dialysis patients following survival from an episode of multiple-organ failure,” Critical Care, vol. 13, no. 3, article no. R65, 2009.
[19]
M. Ostermann and R. Chang, “Renal failure in the intensive care unit: acute kidney injury compared to end-stage renal failure,” Critical Care, vol. 12, no. 5, article no. 432, 2008.
[20]
S. M. Bagshaw, G. Mortis, C. J. Doig, T. Godinez-Luna, G. H. Fick, and K. B. Laupland, “One-year mortality in critically ill patients by severity of kidney dysfunction: a population-based assessment,” American Journal of Kidney Diseases, vol. 48, no. 3, pp. 402–409, 2006.
[21]
A. J. O'Brien, C. A. Welch, M. Singer, and D. A. Harrison, “Prevalence and outcome of cirrhosis patients admitted to UK intensive care: a comparison against dialysis-dependent chronic renal failure patients,” Intensive Care Medicine, vol. 38, no. 6, pp. 991–1000, 2012.
[22]
A. Walcher, S. Faubel, A. Keniston, and P. Dennen, “In critically ill patients requiring CRRT, AKI is associated with increased respiratory failure and death versus ESRD,” Renal Failure, vol. 33, no. 10, pp. 935–942, 2011.
[23]
M. M. Sood, D. Roberts, P. Komenda et al., “End-stage renal disease status and critical illness in the elderly,” Clinical Journal of the American Society of Nephrology, vol. 6, no. 3, pp. 613–619, 2011.
[24]
Y. S. Jung, J. Lee, H. S. Shin, and H. Rim, “Outcomes of patients with end-stage renal disease (ESRD) under chronic hemodialysis requiring continuous renal replacement therapy (CRRT) and patients without ESRD in acute kidney injury requiring CRRT: a single-center study,” Hemodialysis International, vol. 16, no. 4, pp. 456–464, 2012.
[25]
W. A. Knaus, D. P. Wagner, E. A. Draper et al., “The APACHE III prognostic system: risk prediction of hospital mortality for critically III hospitalized adults,” Chest, vol. 100, no. 6, pp. 1619–1636, 1991.
[26]
J. R. Le Gall, S. Lemeshow, and F. Saulnier, “A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study,” Journal of the American Medical Association, vol. 270, no. 24, pp. 2957–2963, 1993.
[27]
J. L. Vincent, A. De Mendon？a, F. Cantraine et al., “Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study,” Critical Care Medicine, vol. 26, no. 11, pp. 1793–1800, 1998.
[28]
R. L. Lins, M. M. Elseviers, R. Daelemans et al., “Re-evaluation and modification of the Stuivenberg Hospital Acute Renal Failure (SHARF) scoring system for the prognosis of acute renal failure: an independent multicentre, prospective study,” Nephrology Dialysis Transplantation, vol. 19, no. 9, pp. 2282–2288, 2004.
