Use of renal replacement therapy after out-of-hospital cardiac arrest in Denmark 2005-2013

Objectives: Renal replacement therapy (RRT) is used to treat acute kidney injury as part of multi organ failure. Use and prognostic implications after out-of-hospital cardiac arrest (OHCA) is not well known.This study aims to assess incidence and use of RRT and whether RRT post-arrest was associated with 30-day mortality in Denmark in the years 2005-2013. Methods: The Danish Cardiac Arrest Registry holds information on all OHCA patients in Denmark from 2005 to 2013. We identified 3,012 one-day survivors of OHCA 18 years, with presumed cardiac aetiology of arrest, admitted to ICU without previous RRT. Change in use of RRT during the study period was assessed using competing risk analysis. Mortality was assessed with Cox regression. Results: On average, RRT was performed in 6% of the patient population with an average annual 1% increase, HR: 1.01, CI: 0.95-1.07, p=.69. Hazard of RRT was lower in patients receiving bystander cardiopulmonary resuscitation (CPR) (p<.001), patients with a shockable primary rhythm (p=.009) and elderly patients (p=.03). Socioeconomic factors did not influence hazard of RRT, but patients admitted to tertiary centres had higher hazard of RRT (p=.009).Use of RRT was associated with increased mortality in multivariate Cox regression (HR: 1.28, CI: 1.06-1.55, p=.01). Conclusion: Use of RRT as part of post resuscitation care following OHCA did not increase from 2005 to 2013; use was more common in tertiary centres and in patients with negative prehospital predictors (no bystander CPR, non-shockable rhythm). RRT was associated with increased mortality.