Association of vasopressor use during renal replacement therapy and mortality

Among critically ill patients with acute kidney injury (AKI) requiring renal replacement therapy (RRT) whether vasopressor use is associated with outcomes is unclear. We examined the association of vasopressor use following RRT initiation with in-hospital mortality in critically ill adults with AKI requiring different modalities of RRT. This observational study was conducted using the Premier Inc. (PINC) AI Healthcare Database of patients (n = 20,882) in U.S. hospitals with AKI requiring continuous RRT (n = 7660) and intermittent hemodialysis ([IHD], n = 13,222) with discharge from January 1, 2018, to June 30, 2021. Data on vasopressor use 3 days before and 3 days after RRT initiation were extracted. Exposure to vasopressors post-RRT initiation was significantly associated with risk-adjusted in-hospital mortality among patients treated with CRRT (risk-adjusted hazard ratio [aHR], 1.69 95 %CI: 1.55-1.85) and IHD (aHR, 1.72, 95 %CI: 1.61-1.84). There was an incremental risk of death associated with the number of vasopressors. Among CRRT patients, the risk of death were: 1 vasopressor (aHR, 1.50; 95 % CI: 1.36-1.65), 2 vasopressors (aHR, 1.94; 95 % CI: 1.76-2.14), and 3 vasopressors (aHR, 2.06; 95 % CI: 1.72-2.46). Similarly, for IHD patients, the aHRs were: 1 vasopressor (aHR, 1.57; 95 % CI: 1.47-1.68), 2 vasopressors (aHR, 2.20; 95 % CI: 2.02-2.40), and 3 vasopressors (aHR, 2.32; 95 % CI: 1.82-2.96). In summary, vasopressor use during the 3 days post-RRT initiation was independently and incrementally associated with higher in-hospital mortality in patients receiving either CRRT or IHD as the first modality.