Renal Replacement Therapy in Patients With Stage IV Cancer Admitted to the Intensive Care Unit With Acute Kidney Injury at a Comprehensive Cancer Center Was Not Associated With Survival.
Ala Abudayyeh, Juhee Song, Maen Abdelrahim and 13 others
PMID 31986903WHAT IT FOUND
For stage IV cancer patients in the ICU with acute kidney injury, starting dialysis did not improve survival compared to not starting it.
Median survival after discharge was 41 days for those who received dialysis and 42 days for those who did not.
Key findings
01Renal replacement therapy was not significantly associated with survival times from the landmark time points in propensity score-matched analyses.
02There was no significant difference in inpatient mortality between patients who received renal replacement therapy and those who did not after adjusting for severity of illness.
03Median long-term survival after hospital discharge was 41 days for patients who received renal replacement therapy and 42 days for those who did not.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was retrospective, meaning it looked back at existing records rather than following patients prospectively, which can introduce bias. The analysis was limited to patients who survived long enough to reach the landmark time points (day 2 or day 7), excluding those who died earlier. Palliative care consultation was extremely rare (1 patient), so the study cannot determine how integrated palliative care might have influenced outcomes or decision-making. The study was conducted at a single comprehensive cancer center, which may limit how well the findings apply to other settings.
The easy way to misread this
Do not conclude that dialysis is harmful or should be universally withheld. The study shows it does not improve survival in this specific group, but individual patient values and goals may still support a time-limited trial.