SUPPLEMENTAL DIGITAL CONTENT
Appendix 1: Final predictive model comparing patients who recovered and patients who did not recover.
OR>1 is associated with better renal recovery.
Variable Odds ratio (95% CI) p
Age 1.011 (1.009-1.014) <0.0001
Non-terminal CKD 0.0008
Class 1 1.011 (0.553-1.847) Class 2 0.948 (0.615-1.463) Class 3 0.981 (0.778-1.237) Class 4 0.546 (0.444-0.671) Class unknown 0.607 (0.537-0.686)
SAPS II 0.998 (0.996-1.000) 0.0637
Vasopressors 1.211 (1.106-1.325) 0.0002
Mechanical ventilation 1.528 (1.392-1.677) <0.0001
Sepsis 1.471 (1.351-1.601) <0.0001
IHD vs. CRRT 0.910 (0.834-0.992) 0.0327
Center size (number of beds) 0.0008
<250 vs >=450 0.659 (0.530-0.818) 250-449 vs >=450 0.832 (0.686-1.010)
Appendix 2: Differences between CRRT group and IHD group before and after propensity matching, population of survivors
Variable
Before PS matching (n=25,750) After PS matching (n=16,816) Initial IHD
(n=9,699) Initial CRRT
(n=16,051) SD* Initial IHD
(n=8,408) Initial CRRT
(n=8,408) SD*
Patients
Age (yr), median (Q1-Q3) 64.0 (54.0-75.0) 64.0 (54.0-74.0) -0.037 65.0 (54.0-75.0) 64.0 (52.0-75.0) -0.057
Men, n (%) 6,145 (63.4) 10,506 (65.5) -0.044 5,372 (63.9) 5,487 (65.3) -0.029
Non-terminal CKD, n (%) 1,663 (17.1) 1,956 (12.2) 0.149 1,380 (16,4) 1,399 (16.6) 0.026
Class 1, n (%) 41 (0.4) 63 (0.4) 36 (0.4) 41 (0.5)
Class 2, n (%) 70 (0.7) 115 (0.7) 59 (0.7) 75 (0.9)
Class 3, n (%) 301 (3.1) 412 (2.6) 247 (2.9) 239 (2.8)
Class 4, n (%) 283 (2.9) 329 (2.0) 239 (2.8) 252 (3.0)
Unknown, n (%) 968 (10.0) 1,037 (6.5) 799 (9.5) 792 (9.4)
Stays
Interval between ICU
admission and first RRT 0.064 0.061
0 day, n (%) 4,902 (50.5) 8,174 (50.9) 4,132 (49.1) 4,067 (48.4)
1 - 3 days, n (%) 3,023 (31.2) 4,694 (29.2) 2,676 (31.8) 2,875 (34.2)
4 - 10 days, n (%) 1,054 (10.9) 1,748 (10.9) 929 (11.0) 887 (10.5)
>10 days, n (%) 720 (7.4) 1,435 (8.9) 671 (8.0) 579 (6.9)
Severity
SAPS II, median (Q1-Q3) 51.0 (40.0-64.0) 55.0 (43.0-68.0) 0.169 52.0 (41.0-65.0) 51.0 (40.0-65.0) -0.030 Vasopressors, n (%) 4,001 (41.3) 10,651 (66.4) -0.520 4,000 (47.6) 3,944 (46.9) 0.013 Mechanical ventilation, n (%) 4,495 (46.3) 10,981 (68.4) -0.458 4,475 (53,2) 4,359 (51.8) 0.028
Sepsis, n (%) 2,719 (28.0) 6,462 (40.3) -0.260 2,611 (31.1) 2,551 (30.3) 0.015
Center size (number of
beds) 0.257 0.092
<250, n (%) 752 (7.8) 2141 (13.3) 752 (8.9) 845 (10.0)
250-449, n (%) 1,919 (19.8) 4,125 (25.7) 1,876 (22.3) 2,147 (25.5)
≥ 500, n (%) 7,028 (72.5) 9,785 (61.0) 5,780 (68.7) 5,416 (64.4)
Annual number of RRT 0.245 0.102
<18, n (%) 377 (3.9) 879 (5.5) 370 (4.4) 419 (5.0)
18-29, n (%) 574 (5.9) 1,838 (11.5) 570 (6.8) 757 (9.0)
30-49, n (%) 1,820 (18.8) 3,452 (21.5) 1,713 (20.4) 1,824 (21.7)
≥50, n (%) 6,928 (71.4) 9,882 (61.6) 5,755 (68.4) 5,408 (64.3)
* SD : Standardized differences. Imbalance defined as absolute value greater than 0.20 (small effect size).
Important imbalance defined as absolute value greater than 0.10.
PS: propensity score
Appendix 3: Comparison of patients who were propensity matched with those who were not propensity matched, population of surviving patients.
Matched patients (n=16,816,
65.3%)
Not matched patients
(n=8,934, 34.7%) p
Patients
Age (yr), median (Q1-Q3) 64.0 (54.0 – 75.0) 64.0 (54.0 – 73.0) <0.0001
Men, n (%) 10,859 (64.6) 5,792 (64.8) 0.6830
Diabetes, n (%) 4,473 (26.6) 2,255 (25.2) 0.0181
Hypertension, n (%) 6,343 (37.7) 3,153 (35.3) <0.0001
Heart failure, n (%) 3,482 (20.7) 1,751 (19.6) 0.0356
Non-terminal CKD, n (%) <0.0001
Class 1, n (%) 77 (0.5) 27 (0.3)
Class 2, n (%) 134 (0.8) 51 (0.6)
Class 3, n (%) 486 (2.9) 227 (2.5)
Class 4, n (%) 491 (2.9) 121 (1.4)
Class unknown, n (%) 1,591 (9.5) 414 (4.6)
Severity of illness
SAPS II, median (Q1-Q3) 52.0 (41.0 – 65.0) 56.0 (44.0 – 69.0) <0.0001
Vasopressors, n (%) 7,944 (47.2) 6,708 (75.1) <0.0001
Mechanical ventilation, n (%) 7,982 (47.5) 6,642 (74.3) <0.0001
Stays
Hospital LOS (days), median (Q1 - Q3) 27.0 (14.0 – 47.0) 33.0 (18.0 – 56.0) <0.0001
Surgical procedure, n (%) 6,528 (38.8) 4,024 (45.0) <0.0001
Multiple ICU stays, n (%) 1,396 (8.3) 862 (9.6) 0.0003
<0.0001
Time between ICU admission and first RRT
0 day n (%) 8,199 (48.8) 4,877 (54.6)
1 - 3 days n (%) 5,551 (33.0) 2,166 (24.2)
4 - 10 days n (%) 1,816 (10.8) 986 (11.0)
>10 days n (%) 1,250 (7.4) 905 (10.1)
Etiological factors
Sepsis, n (%) 5,162 (30.7) 4,019 (45.0) <0.0001
Center size (number of beds) <0.0001
<250, n (%) 1,597 (9.5) 1,296 (14.5)
250-449, n (%) 4,023 (23.9) 2,021 (22.6)
≥500, n (%) 11,196 (66.6) 5,617 (62.9)
Annual number of RRT <0.0001
<18, n (%) 789 (4.7) 467 (5.2)
18-29, n (%) 1,327 (7.9) 1,085 (12.1)
30-49, n (%) 3,537 (21.0) 1,735 (19.4)
≥50, n (%) 11,163 (66.4) 5,647 (63.2)
Appendix 4: Comparison of patients who switched from one modality to the other to those who did not switch.
Patients with switch (n=9,109; 15,5%)
Patients without switch
(n=49,526; 84,5%) p
Patients
Age (yr), median (Q1-Q3) 65.0 (55.0 - 75,0) 67.0 (57.0 – 77.0) <0.0001
Men, n (%) 6,238 (68.5) 3,2347 (65.3) <0.0001
Diabetes, n (%) 2,095 (23.0) 11580 (23.4) 0.4276
Arterial hypertension, n (%) 3,166 (34.8) 1,6784 (33.9) 0.1082
Heart failure, n (%) 2,154 (23.6) 10,776 (21.8) <0,0001
Non-terminal CKD, n (%) <0,0001
Class 1, n (%) 38 (0.4) 161 (0.3)
Class 2, n (%) 51 (0.6) 276 (0.6)
Class 3, n (%) 255 (2.8) 1164 (2.4)
Class 4, n (%) 202 (2.2) 945 (1.9)
Severity unknown, n (%) 686 (7.5) 3168 (6.4)
Severity of illness
SAPS II, median (Q1-Q3) 60.0 (47.0 – 75.0) 60.0 (46.0 – 77.0) 0.0859
Vasopressors, n (%) 6,578 (72.2) 33,881 (68.4) <0,0001
Mechanical ventilation, n (%) 6,980 (76.6) 35,204 (71.1) <0,0001 Stays
Hospital LOS (days), median (Q1 - Q3) 33.0 (18.0 – 57.0) 16.0 (6.0 – 34.0) <0,0001
Surgical procedure, n (%) 4,224 (46.4) 19,119 (38.6) <0,0001
Multiple ICU stays, n (%) 1,112 (12.2) 3,422 (6.9) <0,0001
Sepsis, n (%) 4,515 (49.6) 20,068 (40.5) <0,0001
Time between ICU admission and first RRT (days) <0,0001
0 day, n (%) 4,216 (46.3) 24,283 (49.0)
1 - 3 days, n (%) 2,685 (29.5) 15,072 (30.4)
4 - 10 days, n (%) 1,170 (12.8) 5,970 (12.1)
>10 days, n (%) 1,038 (11.4) 4,201 (8.5)
Modality
IHD, n (%) 3,112 (34.2) -
IHD only, n (%) - 14,618 (29.5)
CRRT, n (%) 5,997 (65.8) -
CRRT only, n (%) - 34,908 (70.5)
Center size (number of beds) <0,0001
<250, n (%) 635 (7.0) 6,830 (13.8)
250-449, n (%) 1,702 (18.7) 12,034 (24.3)
≥ 500, n (%) 6,772 (74.3) 30,662 (61.9)
Annual number of RRT <0,0001
<18, n (%) 221 (2.4) 2,973 (6.0)
18-29, n (%) 571 (6.3) 5,300 (10.7)
30-49, n (%) 1,678 (18.4) 10,479 (21.2)
≥50, n (%) 6,639 (72.9) 30,774 (62.1)
Appendix 5: Differences between CRRT group and IHD group before and after propensity matching, whole population including patients who died in hospital.
Variable
Before PS matching (n=58,635) After PS matching (n=32,826) Initial IHD
(n=17,730) Initial CRRT
(n=40,905) SD* Initial IHD
(n=16,413) Initial CRRT
(n=16,413) SD*
Patients
Age (yr), median (Q1-Q3) 66.0 (56.0-76.0) 67.0 (57.0-76.0) 0.013 67.0 (57.0-77.0) 67.0 (57.0-77.0) 0.001
Men, n (%) 11,536 (65.1) 27,049 (66.1) -0.022 10,769 (65.6) 10,855 (66.1) -0.011
Non-terminal CKD, n (%) 2,655 (15.0) 4,291 (10.5) 0.139 2,471 (15.1) 2,741 (16.7) 0.059
Class 1, n (%) 63 (0.4) 136 (0.3) 61 (0.4) 81 (0.5)
Class 2, n (%) 105 (0.6) 222 (0.5) 103 (0.6) 132 (0.8)
Class 3, n (%) 519 (2.9) 900 (2.2) 495 (3.0) 494 (3.0)
Class 4, n (%) 441 (2.5) 706 (1.7) 432 (2.6) 412 (2.5)
Unknown, n (%) 1,527 (8.6) 2,327 (5.7) 1,380 (8.4) 1,622 (9.9)
Stays
Interval between ICU
admission and first RRT 0.057 0.115
0 day, n (%) 8,301 (46.8) 20,198 (49.4) 7,508 (45.7) 8,096 (49.3)
1 - 3 days, n (%) 5,612 (31.7) 12,145 (29.7) 5,228 (31.9) 4,521 (27.6) 4 - 10 days, n (%) 2,264 (12.8) 4,876 (11.9) 2,157 (13.1) 1,975 (12.0)
>10 days, n (%) 1,553 (8.8) 3,686 (9.0) 1,520 (9.3) 1,821 (11.1)
Severity
SAPS II, median (Q1-Q3) 56.0 (44.0-72.0) 61.0 (47.0-78.0) 0.185 58.0 (45.0-73.0) 55.0 (43.0-72.0) -0.059 Vasopressors, n (%) 9,575 (54.0) 30,884 (75.5) -0.462 9,575 (58.3) 9,166 (55.9) 0.050 Mechanical ventilation, n (%) 10,421 (58.8) 31,763 (77.7) -0.414 10,421 (63.5) 9,813 (59.8) 0.076
Sepsis, n (%) 6,340 (35.8) 18,243 (44.6) -0.181 6,318 (38.5) 6,478 (39.5) -0.020
Center size (number of
beds) 0.234 0.117
<250, n (%) 1,609 (9.1) 5,856 (14.3) 1,609 (9.8) 2,028 (12.4)
250-449, n (%) 3,483 (19.6) 10,253 (25.1) 3,467 (21.1) 3,926 (23.9)
≥ 500, n (%) 12,638 (71.3) 24,796 (60.6) 11,337 (69.1) 10,459 (63.7)
Annual number of RRT 0.223 0.161
<18, n (%) 823 (4.6) 2371 (5.8) 819 (5.0) 867 (5.3)
18-29, n (%) 1,110 (6.3) 4,761 (11.6) 1,109 (6.8) 1,841 (11.2)
30-49, n (%) 3,393 (19.1) 8,764 (21.4) 3,319 (20.2) 3,317 (20.2)
≥50, n (%) 12,404 (70.0) 25,009 (61.1) 11,166 (68.0) 10,388 (63.3)
* SD : Standardized differences. Imbalance defined as absolute value greater than 0.20 (small effect size).
Important imbalance defined as absolute value greater than 0.10.
PS: propensity score
Appendix 6: Comparison of patients who were propensity matched with those who were not propensity matched, whole population including patients who died in hospital.
Matched patients (n=32,826, 56.0%)
Not matched patients
(n=25,809, 44.0%) p Patients
Age (yr), median (Q1-Q3) 67.0 (57.0 - 77.0) 67.0 (57.0 – 76.0) 0.0864
Men, n (%) 21,624 (65.9) 16,961 (65.7) 0.6903
Diabetes, n (%) 8,131 (24.8) 5,544 (21.5) <0.0001
Hypertension, n (%) 11,820 (36.0) 8,130 (31.5) <0.0001
Heart failure, n (%) 7,580 (23.1) 5,350 (20.7) <0.0001
Non-terminal CKD, n (%) <0.0001
Class 1, n (%) 142 (0.4) 57 (0.2)
Class 2, n (%) 235 (0.7) 92 (0.4)
Class 3, n (%) 989 (3.0) 430 (1.7)
Class 4, n (%) 844 (2.6) 303 (1.2)
Unknown, n (%) 3,002 (9.1) 852 (3.3)
Severity of illness
SAPS II, median (Q1-Q3) 56.0 (44.0 – 73.0) 64,0 (50.0 – 79.0) <0.0001
Vasopressors, n (%) 18,741 (57.1) 21,718 (84.1) <0.0001
Mechanical ventilation, n (%) 20,234 (61.6) 21,950 (85.0) <0.0001 Stays
Hospital LOS (days), median (Q1 - Q3) 20.0 (9.0 – 39.0) 16.0 (5.0 – 36.0) <0.0001
Surgical procedure, n (%) 12,725 (38.8) 10,618 (41.1) <0.0001
Multiple ICU stays, n (%) 2,754 (8.4) 1780 (6.9) <0.0001
Time between first day in ICU and first EER <0.0001
0 day, n (%) 15,604 (47.5) 12,895 (50.0)
1 - 3 days, n (%) 9,749 (29.7) 8,008 (31.0)
4 - 10 days, n (%) 4,132 (12.6) 3,008 (11.7)
>10 days, n (%) 3,341 (10.2) 1,898 (7.4)
Etiological factors
Sepsis, n (%) 12,796 (39.0) 11,787 (45.7) <0.0001
Center size (number of beds) <0.0001
<250, n (%) 3,637 (11.1) 3,828 (14.8)
250-449, n (%) 7,393 (22.5) 6,343 (24.6)
≥500, n (%) 21,796 (66.4) 15,638 (60.6)
Annual number of RRT <0.0001
<18, n (%) 1,686 (5.1) 1,508 (5.8)
18-29, n (%) 2,950 (9.0) 2,921 (11.3)
30-49, n (%) 6,636 (20.2) 5,521 (21.4)
≥50, n (%) 21,554 (65.7) 15,859 (61.4)
