Influence of mean arterial pressure on the decision to terminate CRRT and in-hospital mortality: A single-center prospective study

doi:10.21203/rs.3.rs-2372752/v1

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Influence of mean arterial pressure on the decision to terminate CRRT and in-hospital mortality: A single-center prospective study

https://doi.org/10.21203/rs.3.rs-2372752/v1

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Background

We hypothesized that a low mean arterial pressure (MAP) at CRRT initiation would influence the early death or withdrawal of CRRT and in-hospital mortality.

Methods

This prospective cohort study collected data for CRRT patients seen at the Third Affiliated Hospital from January 2016 to December 2020. We collected MAP data at the initiation of CRRT, reasons for CRRT termination, and in-hospital mortality data. We divided the patients into four groups based on quartiles of the initial MAP and analyzed its influence on early death/withdrawal of CRRT.

Results

A total of 2,346 patients with acute kidney injury (AKI) were included in this study. The median age of the participants was 68.0 (57.0–76.0) years, and 62.4% were male. CRRT was discontinued in 49.9% of our patients after renal recovery or HD transition; in 48.8%, CRRT was terminated by death (36.6%) or withdrawal (12.2%). An initial low MAP (Q1, MAP ≤ 69 mmHg and Q2, MAP ≤ 77.1 mmHg) was associated with a 1.3-fold greater risk of death/withdrawal during CRRT. Older age, a higher SOFA score, and oliguria at the time of CRRT initiation also predicted death/withdrawal during CRRT.

Conclusions

In patients on CRRT, a lower MAP at CRRT initiation was closely associated with a higher probability of terminating CRRT due to death/withdrawal, and it was associated with an increased risk of in-hospital mortality.

acute kidney injury

continuous renal replacement therapy

mean arterial pressure

CRRT withdrawal

withdrawal of life support treatment

Continuous renal replacement therapy (CRRT) was introduced in 1977 ¹ to eliminate the shortcomings of intermittent hemodialysis (HD) and has become the RRT modality of choice for hemodynamically unstable patients with acute kidney injury (AKI) in intensive care units (ICUs) ². However, hypotension still develops in 10–35% of cases on CRRT ^3,4, usually resulting in early CCRT termination or withdrawal without achieving the clinical goal.

Discontinuation of CRRT is considered when intrinsic kidney function has recovered or RRT is no longer consistent with the goals of care ². Withdrawal of CRRT differs from intended discontinuation, which includes do-not-resuscitate (DNR) orders signed during CRRT, sustained hypotension, or a high probability of patient deterioration despite aggressive treatment ⁵. On post hoc analysis of the BEST KIDNEY database ⁶, successful discontinuation or repeat RRT was observed in 52.5% of cases whereas the other 47.5% ceased CRRT because of death (32.8%), transfer to another hospital (1.2%), or withdrawal (13.4%).

Withdrawal of life support occurs in 10% of all patients in general ICUs, and it is responsible for about 40% of all deaths ⁵. CRRT is one of the most likely therapies to be discontinued during withdrawal of life support; however, little is known about the factors associated with withdrawal.

We hypothesized that an initial low MAP is associated with an increased risk of CCRT withdrawal and death. We explored how the MAP at CRRT initiation affected CRRT termination, and the influence of MAP on death during CRRT or CRRT withdrawal.

Study population

A total of 2,863 patients received CRRT during the study period. After excluding 7 patients < 18 years of age, 421 with ESKD, and 52 with missing data, 2,346 patients were eligible for the analysis (Fig. 1). We grouped the patients according to MAP quartiles. The cut-offs and mean BPs of each quartile were as follows: first (Q1), ≤ 69 (mean, 59.8 ± 7.6) mmHg; second (Q2), 69.1–77.7 (mean, 6.4 ± 2.4) mmHg; third (Q3), 77.8–89.0 (mean, 83.0 ± 3.1) mmHg; and fourth (Q4), ≥ 89.1 (mean, 101.2 ± 19.3) mmHg.

Baseline characteristics

The baseline characteristics of the patients and demographics by MAP quartiles are shown in Table 1. The median age of the participants was 68.0 (57.0–76.0) years, and 62.4% were male. Hypertension (56.1%) was the most common comorbidity, followed by diabetes (39.6%), heart disease (29.9%), chronic kidney disease (24.2%), cancer (14.9%), liver cirrhosis (13.8%), CVD (12.0%), and lung disease (8.4%). The rates of CKD and cerebrovascular disease were the lowest in Q1 and increased with higher MAP quartiles (p for trend < 0.05).

Table 1

Baseline characteristics of patients by MAP at CRRT initiation
	1st Quartile (N = 599)	2nd Quartile (N = 588)	3rd Quartile (N = 573)	4th Quartile (N = 586)
Demographics
Age, year	68(56–76)	68(58, 77)	68(58, 76)	66(55, 76)	0.169
Male, %	61.4	65.0	61.1	62.1	0.506
BMI, kg/m2	23.5 ± 4.1	23.5 ± 4.4	23.9 ± 4.8	23.4 ± 4.0	0.362
Comorbidities
Diabetes, %	36.2	40.0	42.2	40.4	0.187
Hypertension, %	52.3	57.4	59.9	55.8	0.066
Liver Cirrhosis, %	16.3	14.7	12.3	12.0	0.109
Heart disease, %	27.2	31.3	30.6	31.2	0.386
Lung disease %	8.4	9.7	7.7	7.7	0.571
CKD, %	17.4	22.5	24.3	33.2	< 0.001
Cerebrovascular ds%	9.1	12.9	12.0	14.4	0.037
Cancer,%	16.7	16.0	15.4	11.9	0.095
Disease Severity at CRRT initiation
Sepsis, %	31.6	26.4	20.1	16.2	< 0.001
Anuria, %	72.5	63.1	59.6	56.6	< 0.001
MAP, mmHg	59.8 ± 7.6	76.4 ± 2.4	83.0 ± 3.1	101.2 ± 19.3	< 0.001
Vasopressors, %	72.6	60.8	58.7	54.3	< 0.001
Ventilator, %	88.5	72.2	60.4	48.2	< 0.001
SOFA score	12.4 ± 3.7	10.9 ± 3.9	10.1 ± 3.7	8.9 ± 3.8	< 0.001
Laboratory results at CRRT start
WBC, 10E3/uL	13.8 ± 10.8	14.2 ± 11.3	14.1 ± 12.7	14.1 ± 9.8	0.886
Platelet, 10E3/uL	137.6 ± 101.3	149.7 ± 111.2	151.3 ± 123.5	170.3 ± 107.7	0.049
Hemoglobin, g/dL	10.6 ± 5.4	10.4 ± 4.2	10.3 ± 4.2	10.9 ± 5.2	0.007
Total protein, g/dL	5.5 ± 5.9	5.4 ± 1.2	5.5 ± 1.2	5.8 ± 2.9	< 0.001
Albumin, g/dL	2.9 ± 1.2	3.1 ± 3.1	3.0 ± 0.6	3.2 ± 1.2	< 0.001
BUN, mg/dL	50.5 ± 33.1	56.5 ± 37.9	58.9 ± 34.9	54.5 ± 34.9	0.045
Creatinine, mg/dL	3.5 ± 9.0	3.2 ± 2.3	3.4 ± 2.8	3.5 ± 2.9	0.083
Sodium, mmol/L	137.7 ± 9.9	136.5 ± 10.1	137.5 ± 8.1	137.0 ± 6.9	0.658
Potassium, mmol/L	4.9 ± 6.6	4.7 ± 4.3	4.5 ± 1.1	4.6 ± 1.1	0.154
PT, INR	1.9 ± 1.4	1.7 ± 0.9	1.9 ± 2.3	1.5 ± 0.7	< 0.001
Abbreviations: Alb, albumin; CRRT, continuous renal replacement therapy; BMI, body mass index; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; CKD, chronic kidney disease; MAP, mean arterial pressure; SOFA, sequential organ failure assessment; WBC, white blood cell; BUN, blood urea nitrogen; PT, prothrombin time; ICU, intensive care unit; RRT, renal replacement therapy, * p value for trend

At the time of CRRT initiation, the rates of sepsis (1Q, 31.6%; 4Q, 16.2%), anuria (1Q, 72.5%; 4Q, 56.6%), vasopressor requirement (1Q, 72.6%; 4Q, 54.3%), and ventilator requirement (1Q, 88.5%; 4Q, 48.2%) decreased with increasing MAP quartile. The mean Sequential Organ Failure Assessment (SOFA) score was the highest in Q1 (12.4 ± 3.7), followed by Q2 (10.9 ± 3.9), Q3 (10.1 ± 3.7), and Q4 (8.9 ± 3.8). The platelet count and serum albumin level were lowest, while the prothrombin time (international normalized ratio) was highest, in Q1.

Reasons for CRRT termination and their associations with the initial MAP

CRRT was performed during a median of 3 (2, 6) days, with a mean actual delivered dose of 34.0 ± 6.9 kg/ml/h. Renal recovery (36.8%) and death (36.6%) were the most common reasons for terminating CRRT, followed by the transition to HD (13.1%), a DNR order (7.2%), unstable BP (3.8%), and transfer to a nursing care facility (1.2%).

Of the 2,346 patients, 1,171 (49.9%) discontinued CRRT, and 1143(48.7%) stopped CRRT due to early death or withdrawal; the proportion differed by the MAP quartile. As MAP increased, the proportion of discontinuations increased, and those of death/withdrawal decreased (Fig. 2). Details on the proportions by MAP quartile are described in Table 2.

Table 2

Course of disease after CRRT
	1st Quartile (N = 599)	2nd Quartile (N = 588)	3rd Quartile (N = 573)	4th Quartile (N = 586)	P*
CRRT implementation
ICU to RRT, days	1(0, 1.5)	1(0, 2)	1(0, 3)	0(0, 1)	< 0.001
Duration, days	3(2, 5)	3(2, 7)	4(2, 7)	3(2, 6)	< 0.001
Delivered dose, ml/kg/hr	34.1 ± 7.6	33.7 ± 7.0	34.3 ± 6.7	33.9 ± 6.5	0.501
% Down time	4.5 ± 8.7	6.1 ± 11.5	6.3 ± 11.8	6.4 ± 11.3	0.015
Reasons to stop CRRT, N(percentage)
Discontinuation
Renal recovery	182(30.4)	200(34.0)	231(40.3)	250(42.7)	< 0.001
Transit to HD	44(7.3)	68(11.6)	75(13.1)	121(20.6)	< 0.001
Death/Withdrawal
Death	275(45.9)	231(39.3)	201(35.1)	151(25.8)	< 0.001
DNR order	51(8.5)	43(7.3)	39(6.8)	36(6.1)	0.109
Sustained low BP	34(5.7)	27(4.6)	14(2.4)	13(2.2)	< 0.001
Transfer out	5(0.8)	9(1.5)	6(1.0)	8(1.5)	0.574
Length of stay, days(IQR)
at ICU	6(2, 16)	8(3, 17)	8(4, 18)	8(4, 15)	0.044
In hospital	12(2, 33)	16(3, 38)	18(6, 45)	17(6, 35)	0.145
Mortality, N(percentage)
ICU mortality	276(66.0)	229(58.9)	181(48.7)	146(38.4)	< 0.001
In-hospital mortality	396(67.1)	343(59.7)	284(50.9)	227(40.1)	< 0.001
Abbreviations: CRRT, continuous renal replacement therapy; HD, hemodialysis; BP, blood pressure; DNR, do not resuscitation; ICU, intensive care unit, * p value for trend
Data regarding inhospital mortality were missing for 57 patients (2.4%).
Data regarding ICU mortality were missing for 787 patients (33.5%).

The effect of MAP on death/withdrawal of CRRT was analyzed. In univariate and multivariate analyses, MAP quartiles Q1 and Q2 had an increased risk of events compared to Q4 (Q1: HR 1.312 [1.032–1.669], Q2: HR 1.306 [1.027–1.662]). Older age (HR 1.017 [1.011–1.024]), a high SOFA score (HR 1.128 [1.103–1.154]), and oliguria at CRRT initiation (HR 1.226 [1.022–1.469]) were also associated with death/withdrawal of CRRT (Table 3).

Table 3

Multi-variable Cox regression analysis results on predicting death/withdrawal of CRRT
	HR(95% CI)	P-value
Mean arterial pressure, mmHg
1st Quartile	1.312(1.032–1.669)	0.027
2nd Quartile	1.306(1.027–1.662)	0.030
3rd Quartile	1.062(0.828–1.363)	0.635
4th Quartile	Reference
Age, year	1.017(1.011–1.024)	< 0.001
SOFA score	1.128(1.103–1.154)	< 0.001
Anuria at CRRT initiation, yes	1.226(1.022–1.469)	0.028
Final model: adjusted with age, BMI, COPD, CKD, sepsis, SOFA score and CRRT delivered dose
Abbreviations: SOFA, sequential organ failure assessment; BMI, body mass index;; COPD, chronic obstructive pulmonary disease; CKD, chronic kidney disease; CRRT, continuous renal replacement therapy

Relationships among MAP, length of hospital stay, in-hospital mortality, and RRT dependence

The median length of stay in the ICU and hospital was 8 (3–16) and 16 (4–37) days, respectively, and did not differ according to the initial MAP quartile. Information on in-hospital mortality was available in 2,288 (97.5%) of the 2,346 enrolled patients, of these; 1,250 (54.6%) died. The in-hospital mortality rate was the highest in Q1 (67.1%), followed by Q2 (59.7%), Q3 (50.9%), and Q4 (40.1%), as consistently revealed by the Kaplan-Meier survival curves (Fig. 3). Of the 1,169 patients who stopped CRRT because of death/withdrawal, 1,101 (94.2%) died, whereas only 149 (13.3%) of 1,120 patients who discontinued CCRT died in the hospital.

On multivariate analyses adjusted by disease severity, termination of CRRT because of death/withdrawal increased the risk of in-hospital mortality 18.6-fold compared to CRRT discontinuation (HR 18.558 [14.086–24.451]). Other risk factors significant in terms of in-hospital mortality were old age (HR 1.013 [1.007–1.020]), higher SOFA score (HR 1.140 [1.116–1.654]), and male sex (HR 1.230 [1.034–1.464]) (Table 4).

Table 4

Multi-variable Cox regression analysis results on predicting in-hospital mortality
	HR (95%CI)	P-value
Model I
Mean arterial pressure, mmHg
1st Quartile	1.160(0.910,1.480)	0.231
2nd Quartile	1.195(0.938,1.522)	0.150
3rd Quartile	0.981(0.760,1.266)	0.882
4th Quartile	Reference
Age, year	1.013(1.007,1.020)	< 0.001
SOFA score	1.140(1.116, 1.654)	< 0.001
Model II
Reasons for CRRT termination
Discontinuation	Reference
Death/Withdrawal	18.558(14.086, 24.451)	< 0.001
Male	1.230(1.034, 1.464)	0.019
Factors adjusted for final model I were age, sex, BMI, COPD, CKD, sepsis, SOFA score, CRRT delivered dose, and MAP at CRRT start
Factors adjusted for final model I were age, sex, BMI, COPD, CKD, sepsis, SOFA score, CRRT delivered dose, and reasons for CRRT termination
Abbreviations: SOFA, sequential organ failure assessment; BMI, body mass index;; COPD, chronic obstructive pulmonary disease; CKD, chronic kidney disease; CRRT, continuous renal replacement therapy

Of the 1,039 patients who survived after CRRT, 119 (11.5%) were RRT-dependent at hospital discharge. The RRT dependency rate did not differ according to the initial MAP. Of the 971 patients in whom CRRT was discontinued, 23 (3.2%) of 724 whose kidneys recovered became RRT-dependent, and 93 (37.5%) of 248 who transitioned to HD remained RRT-dependent at hospital discharge.

In this single-center, prospective cohort study, we evaluated the reasons for terminating CRRT in association with MAP, and its influence on death/withdrawal during CRRT. CRRT was discontinued in 49.9% of our patients after renal recovery or HD transition, whereas another 50% terminated CRRT due to death/withdrawal. An initially low MAP (Q1, MAP ≤ 69 mmHg and Q2, MAP ≤ 77.1 mmHg) had a 1.3-fold higher risk, and older age, a higher SOFA score, and oliguria at CRRT initiation were the additional risk factors. Among patients in whom CRRT was discontinued after kidney recovery or transitioning to HD, only 13.3% died, whereas 94.3% of patients who died/withdrew from CRRT died in the hospital, corresponding to 19-fold higher odds of in-hospital mortality.

Withdrawal of life-sustaining treatment from critically ill patients has been previously studied in diverse life supporting modalities. In the study of Sjokvist et al. ⁷, physician’s perception that the patient preferred not to use life support, physician prediction that the patient’s likelihood of survival in the ICU was < 10%, a high likelihood of poor cognitive function, and the use of inotropes or a vasopressor independently affected the decision to withhold ventilator therapy. In a nationwide survey in a German cardiac ICU ⁸, multi-organ failure, failure of assist device therapy, a poor cardiac index, a poor expected quality-of-life, and patient desire to limit medical care were important. In a prospective study of 37 ICUs in 17 European countries ⁹, limiting therapy was related to patient age, acute and chronic diagnoses, the number of days in the ICU, the frequency of patient turnover, and religion.

Withdrawal of CRRT is not uncommon in ICUs. In the BEST KIDNEY study ⁶, 135 (13.4%) of 1,006, and, in our cohort, 285 (12.1%) of 2,346, withdrew. However, little is known about the precipitating factors. As a futile prognosis is a relative contraindication to CRRT initiation ¹⁰, our information on the risk factors for death/withdrawal of CRRT should help decision-making in terms of CRRT initiation, in turn reducing the therapeutic burden.

Hypotension is associated with ICU patients’ outcomes. In a retrospective study of septic patients conducted in 110 US hospitals, the odds of in-hospital mortality increased 11.4 (95% CI, 7.8–15.1)%, AKI increased 7.0 (95% CI, 4.7–9.5)%, and myocardial injury increased 4.5-fold (95% CI, 0.4–8.7)% when the time-weighted average MAP was < 65 mmHg ¹¹. In a retrospective analysis of the Medical Information Mart for Intensive Care database (Boston, MA, USA), MAP < 65 mmHg lasting > 2 hours was associated with 1.76-fold higher odds of ICU mortality ¹². Relatively higher MAP cut-off levels were suggested for CRRT patients. A retrospective study of 2,292 AKI patients who underwent CRRT reported that MAP < 82.7 mmHg at the initiation of CRRT was associated with 1.21 (1.01–1.45)-fold higher odds of mortality ¹³. Our study showed that a MAP < 77.1 mmHg at CRRT initiation was associated with a 1.3-fold higher risk of death/withdrawal during CRRT. Maintenance of kidney perfusion, ultrafiltration, and cardiac stunning ¹⁴ may be associated with higher MAP requirements in CRRT patients compared to other critically ill patients without CRRT.

Older age is a traditional risk factor for withdrawal of life support therapy^9,15 and mortality in patients admitted to the ICU ¹⁶. Consistently, each 1-year increase in age was associated with a 1.7% higher risk of death/withdrawal of CRRT and a 1.3% higher risk of in-hospital mortality in our cohort. Multiple comorbidities, delayed resuscitation ¹⁸, and a higher level of DNR instructions ¹⁹ may have been important in this regard.

The SOFA score predicts the outcomes of critically ill patients ²⁰; consistent with previous studies ²¹, a higher SOFA score at CCRT initiation was predictive of death/withdrawal of CRRT. Unlike age, the SOFA score changes in response to treatment. Flavio et al. ²² showed the usefulness of serial evaluation of the SOFA score to predict the outcomes of critically ill patients; an increase in the SOFA score during the first 48 hours in the ICU predicted a mortality rate of at least 50%, and a decrease in the SOFA score predicted a mortality rate < 27%, independent of the initial score. The SOFA score decreases with appropriate treatment of patients requiring CRRT; thus, the pattern of change in the SOFA score during the course of disease might be a more reliable predictor of withdrawal of therapy rather than a single SOFA score calculated at CRRT initiation. This needs to be evaluated in future studies.

Oliguria is a poor prognostic marker for AKI ²³. Etienne et al. ²⁴ reported that patients with oliguric AKI had an increased mortality rate, increased dialysis requirements, and longer ICU and hospital stays compared to those without. Nathan et al. ²⁵ showed that oliguria lasting > 12 hours was associated with a higher risk of 90-day mortality in 15,620 critically ill patients. As the expected- QOL after ICU survival is important when deciding to withdraw life support treatment⁸; oliguria is an explainable factor in predicting early death or withdrawal of CRRT.

Several limitations of this study should be discussed. First, as each physician made the decision to terminate CRRT, clear criteria for kidney recovery and HD transition have not been defined. Therefore, uniform CRRT termination criteria were unavailable. Second, the detailed reasons for withdrawal of CRRT were not collected. Third, the reasons why CCRT was initiated were not described.

We found that about 13% of patients withdrew from CRRT in ICUs, strongly associated with an increased risk of in-hospital mortality. A low MAP at CRRT initiation, older age, a higher SOFA score, and oliguria at CRRT initiation were the relevant risk factors. An additional prospective study is needed to predict a futile prognosis at the time of CRRT initiation.

Study design and population

This prospective observational study enrolled patients who underwent CRRT from January 2016 to December 2020 in the ICU of the Third Affiliated Hospital. Patients with AKI, with or without chronic kidney disease (CKD), and who received CRRT were included. We excluded patients aged < 18 years, with end-stage kidney disease on maintenance dialysis before starting CRRT, or for whom data were missing (Fig. 1).

Data collection and definitions

The parameters of interest included demographics, comorbidities, disease severity, and laboratory data at the time of initiating CRRT. The demographic data included age, sex, body weight, and comorbidities (i.e., diabetes mellitus, hypertension, liver cirrhosis, heart disease, lung disease, CKD, cerebrovascular disease, and cancer). Disease severity at the time of initiation of CRRT was assessed using the SOFA²¹. A blood test was performed at the time of CRRT initiation, including a complete blood count; assays of sodium, potassium, blood urea nitrogen, creatinine, total protein, and albumin levels; and the prothrombin time. We defined oliguria as a mean urine output of < 0.5 mL/kg/h for > 6 h ²⁶. MAP was calculated at the time of initiating CRRT as follows: (systolic blood pressure [BP] + 2 × diastolic BP)/2 ²⁷. The time from ICU admission to CRRT initiation, the total duration of CRRT (days), and the actual delivered dose were calculated.

The reasons for stopping CRRT included renal recovery, transition to HD, unable to maintain CRRT because of low BP, DNR orders, death, and transfer to a nursing care facility. We grouped the reasons into “discontinuation” or “death/withdrawal” as follows: “discontinuation” included renal recovery and transition to HD, while “death/withdrawal” included death during CRRT, low BP, a DNR order, and transfer to a nursing care facility.

CRRT

The decision to initiate CRRT was made at the discretion of the attending physician. We performed CRRT in continuous veno-venous hemodiafiltration mode. The details of our CRRT methods are described elsewhere ^28,29. A decision to stop CRRT was made by a nephrologist when signs of renal recovery were observed, the volume of spontaneous urine output increased by > 200–500 mL/day, or the disease burden was to an extent that it could be controlled by the patient ³⁰. A patient was transitioned to HD if his/her BP became stable without the assistance of inotropes but did not meet the criteria for renal recovery. CRRT was withdrawn in cases with a sustained low BP (MAP < 60 mmHg), despite multiple vasopressors or inotropes, or when a DNR order was made by guardians.

Outcomes

The primary outcomes were the reasons for CRRT termination and their associations with MAP. The secondary outcomes were the influence of MAP on the length of hospital stay and in-hospital mortality.

Statistical analysis

We grouped the patients into MAP quartiles and evaluated the effect of MAP on the outcomes. We checked the normality of data using the Kolmogorov-Smirnov test. Continuous variables are expressed as medians with interquartile ranges or as means ± standard deviations, as appropriate. The four groups were compared using a one-way analysis of variance, with the Bonferroni correction. Categorical variables are expressed as percentages; proportions were compared using the chi-square test.

The effects of MAP on death/withdrawal of CRRT and in-hospital mortality were analyzed using univariate and multivariate Cox proportional hazards models. The full model was adjusted for age, sex, body mass index (BMI), diabetes, liver cirrhosis, chronic obstructive pulmonary disease (COPD), CKD, sepsis, hemoglobin, the SOFA score, number of days from ICU admission to CRRT, actual delivered CRRT dose, and CRRT duration. For the final model, backward selection was used based on the Wald test, with a 0.2 threshold for all predictors (age, BMI, COPD, CKD, SOFA score, and actual delivered CRRT dose).

All statistical tests were two-sided, and p-values < 0.05 were considered significant. Data were analyzed and plotted using IBM SPSS software (ver. 29.0; IBM Corp., Armonk, NY, USA).

Ethical statement

This study was conducted in accordance with the Declaration of Helsinki. Approval to perform analyses was obtained with a waiver of informed consent from the Pusan National University IRB Committee [2208-002-117]

Disclosure: All authors have no conflict of interest.

Acknowledgements: None

Consent for publication: Not applicable

Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Completing interests: None of the authors have any potential conflicts of interest

Funding: This work was supported by the National Research Foundation of Korea(NRF) Grant funded by the Korean government (MIST) (No.2022R1C1C1009362).

Authors’ contributions

YJ wrote the manuscript. JG and KDW collected the data. KHJ, SSH and SEY performed data curation and validated the final manuscript. RH conceptualized, designed the study, and reviewed the whole manuscript and approved the final version to be submitted.

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No competing interests reported.

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Influence of mean arterial pressure on the decision to terminate CRRT and in-hospital mortality: A single-center prospective study

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Abstract

Background

Methods

Results

Conclusions

Figures

Introduction

Results

Study population

Baseline characteristics

Reasons for CRRT termination and their associations with the initial MAP

Relationships among MAP, length of hospital stay, in-hospital mortality, and RRT dependence

Discussion

Methods

Study design and population

Data collection and definitions

CRRT

Outcomes

Statistical analysis

Declarations

References

Additional Declarations

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