Comparative Outcomes and Risk Analysis of Kidney Replacement Therapy in Adult Patients with AKI

Background: Acute kidney injury (AKI) is a condition present in nearly 7% of hospital admissions and 30% of ICU admissions with significant mortality and is linked to several major comorbidities including diabetes, sepsis, and heart failure. We utilized aggregated electronic healthcare patient data to analyze the incidence of AKI comorbidities, characterize epidemiological data, and compare patient outcomes between those on IHD (Intermittent Hemodialysis) and CKRT (Continuous Kidney Replacement Therapy). Methods: A retrospective cohort assessment was performed using the TrinetX database. We studied the incidence rates of diabetes mellitus, primary hypertension, heart failure, and sepsis in ICU HD AKI patients at a 365-day period preceding AKI onset. Additionally, we evaluated clinical outcomes among ICU AKI HD patients compared to CKRT patients by measuring rehospitalization rates, intensive care unit (ICU) readmission, mechanical intubation/ventilation, and all-cause mortality risk at 30, 90, 180, and 365-days post-treatment. Results: Hypertension (20.2%), sepsis (9.23%), and diabetes mellitus (7.28%) were the most common comorbidities in the AKI patient cohort. Comparative outcomes analysis showed increased mortality and ICU readmission in the CKRT AKI patient cohort and higher rehospitalizations in the HD AKI patient cohort. Both groups demonstrated similar ventilation/intubation rates. Conclusion: Our ICU CKRT and HD cohort comparison indicates a significant increase in mortality and ICU readmission rates among CKRT patients. HD patients reported higher rehospitalization rates, while ventilation/intubation rates were similar between cohorts. The competing risks analysis for our HD AKI cohort demonstrated strong links between comorbidities and patients needing HD treatment.