The Impact of Chronic Kidney Disease on In-Hospital Outcomes in Patients With Acute Respiratory Distress Syndrome.

BACKGROUND

Acute respiratory distress syndrome (ARDS) is associated with high mortality rates in critically ill patients. Renopulmonary interplay remains crucial in contributing to the outcomes in patients with ARDS. While the role of acute kidney injury has been widely explored in these patients, there remains an unmet need in the literature about the impact of chronic kidney disease (CKD) in these patients.

RESEARCH QUESTION: Is there a quantifiable association between CKD and in-hospital outcomes in patients with ARDS?

STUDY DESIGN AND

METHODS

We utilized a retrospective study design to compare descriptive statistics and outcomes in patients with ARDS with or without CKD. Pearson's chi-square test was used to compare categorical variables, while the Wilcoxon rank sum test was used for continuous variables. We also performed multivariate logistic regression analyses for each outcome and adjusted for demographics and comorbidities. Lastly, we conducted a sensitivity analysis using propensity score-matched outcomes between these groups.

RESULTS

Among 479,450 patients with ARDS, 17.6% also had CKD, while 82.4% did not. Patients with ARDS and CKD were older (median age: 71 years vs. 60 years, p < 0.001) and comprised a greater proportion of males (59.4% vs. 55.9%, p < 0.001). CKD was associated with increased odds of in-hospital mortality (adjusted odds ratio [aOR] 1.29, p < 0.001), acute heart failure (aOR 1.26, p < 0.001), ventricular arrhythmias (aOR 1.16, p < 0.001), cardiogenic shock (aOR 1.10, p = 0.044), major adverse cardiovascular events (aOR 1.29, p < 0.001), and length of stay ≥ 7 days (aOR 1.05, p = 0.033).

INTERPRETATION: Our study provides insights into the magnitude of impact renal diseases may have on the outcomes of patients with ARDS. Further prospective studies are warranted to establish more substantial epidemiological evidence of this relationship to tailor the management of such patients.