Intensive Care Medicine, Published: 30 June 2025
Purpose
In numerous high-risk medical and surgical conditions, an
increased volume of patients and procedures is associated with improved
processes and survival. This study examined the association of hospital-level
continuous kidney replacement therapy (CKRT) utilization rates with all-cause
hospital mortality in critically ill patients with acute kidney injury (AKI).
Methods
This multicenter cohort study used data from patients
admitted to the intensive care unit (ICU) within the Premier Incorporated AI
(PINC-AI) database. Patients were critically ill adults with AKI receiving
kidney replacement therapy (KRT) in U.S. hospitals that offered both CKRT and
intermittent hemodialysis. Hospitals were characterized according to their CKRT
utilization in the ICU, and risk-adjusted association with all-cause hospital
mortality by day 90 was estimated.
Results
Among 49,685 patients with AKI admitted to 426 acute care
U.S. hospitals and treated with KRT in the ICU, a higher hospital-level CKRT
utilization rate was associated with lower patient-level risk-adjusted hospital
mortality. Hospitals with higher CKRT utilization rates (CKRT use in ≥ 31.5% of KRT patients per year)
had a 15% lower adjusted probability of death compared with hospitals with
lower CKRT utilization rates (CKRT use in < 8% of KRT patients per year).
When compared with the first quartile of hospital-level CKRT use, the third
(adjusted hazard ratio [aHR], 0.93, 95%CI: 0.89–0.98) and fourth (aHR, 0.85,
95%CI: 0.81–0.89) quartiles were associated with lower risk-adjusted hospital
mortality. Findings were consistent in several sensitivity analyses.
Conclusions
Among critically ill adults with AKI requiring KRT,
treatment in hospitals with higher CKRT utilization rates was associated with
reduced hospital mortality.
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