P46
OUTCOME DATA FOR A UK RENAL WARD-BASED HIGH DEPENDENCY UNIT
Kamalanathan, M, Sharpe, C, Onipede, T, Shah, S
King’s College Hospital Renal Unit, Denmark Hill, London
OBJECTIVES: To assess the outcomes of acutely ill patients requiring renal replacement
therapy who were admitted to a renal ward-based high dependency unit (HDU) in a one year
period
.
SETTING: A South London tertiary referral renal unit with capacity for 4 HDU beds.
BACKGROUND: The requirement for renal replacement therapy (RRT) including continuous
veno-venous haemofiltration (CVVH) with or without second organ support in the acutely ill
patient often precipitates a need for transfer to a dedicated intensive therapy unit (ITU). A
number of patients however, who do not require invasive ventilation, can be cared for in a high
dependency setting if the staff and facilities are available.
DESIGN: This is a retrospective analysis of patients requiring renal replacement therapy (RRT)
plus circulatory support and/or non-invasive ventilation (NIV) who were admitted to our renal
HDU between January and December 2009. Outcome data (survival, dialysis dependence and
dialysis independence at the time of discharge) were correlated with age, gender, ethnicity,
necessity for inotropes and noninvasive ventilation in univariate analysis by means of chisquare tests. Logistic regression analysis was performed to investigate associations between the
variables described and outcome in multivariate analysis. All analyses were performed using
SAS software (version 9.1.3; SAS Institute, Marlow, Bucks, UK).
RESULTS: 68 patients were identified with acute or acute on chronic kidney injury (AKI) or
with pre-existing end-stage kidney disease (ESKD) who required admission to our HDU
between January and December 2009. The mean age across all groups was 65 (63 for AKI
(n=22), 71 for Acute on chronic kidney injury (A/CKI) (n=25) and 59 for ESKD (n=21)). The
in-hospital mortality rates for AKI, A/CKI and ESKD were 23%, 24% and 43% respectively.
10% patients (n=7) required transfer to ITU for invasive ventilation. 49% of patients with AKI
or A/CKI were dialysis independent at discharge. In those patients with pre-existing normal
renal function, 89% were dialysis independent at discharge.
In multivariate analysis adjusting for age, use of inotropes, non-invasive ventilation and
baseline renal function (ie ESKD, AKI or A/CKI), only the use of inotropes was found to
significantly and indirectly correlate with survival (OR 6.9 95% CI [1.2-37.3] P=0.03).
Although no significant correlation was found between age and mortality there was a trend
towards worsening mortality and increasing age (24% with age < 65 group, 30% with age 65-80
and 50% with age > 80). There was no association between gender or ethnicity and outcome.
CONCLUSION: These outcome data compare favorably with previously published outcomes
for acutely ill patients with AKI, A/CKI or ESKD requiring RRT plus other organ support in an
intensive care setting. This type of ward-based high dependency care is cheaper than an
intensive care unit admission and can provide safe and effective treatment for patients who
require RRT plus other organ support but who do not require invasive ventilation. In addition,
this type of care may also be more accessible to patients who would otherwise be deemed not
suitable for ITU but may benefit from a higher level of care than a non-HDU acute medical
ward can provide.