Renal replacement therapy, including hemodialysis, can reduce the death risk in patients with severe acute kidney injury after a heart attack, a group of researchers said in a recent report.

Chung-Ang University Hospital Professors Oh Je-hyeok and Lee Dong-hoon and Ewha Womans University Medical Center Professor Choi Yoon-hee conducted a joint study and found that renal replacement therapy lowers the risk of death among patients who had received targeted temperature treatment after out-of-hospital cardiac arrest.

Professor Oh Je-hyeok of the Department of Emergency Medicine at Chung-Ang University Hospital

The research team studied the psychological effect and condition of renal replacement therapy – hemodialysis, peritoneal dialysis and kidney transplant -- on 223 patients from October 2015 to December 2018. In the study, the team used the prospective observational data of Korea Hypothermia Network, participated in by 22 general hospitals.

The result showed that 115 patients, or 51.6 percent of the total, had a history of renal replacement therapy with severe kidney injury. The mortality rate of those who had not received renal replacement therapy at six months was 91 percent, or 98 out of 108 patients. However, those who took the therapy at six months showed 81 percent death rate, which was significantly lower than those without the treatment.

Besides, renal replacement therapy on patients with cerebral performance category (CPC) stage 1, who had the best CPC, resulted in a better neurological outcome in 12 among 115 patients, or 10 percent. Only three patients who did not receive the therapy have shown a neurological outcome at the sixth month.

According to the variables-controlled analysis conducted by the research team, applying renal replacement therapy considerably decreased the risk of fatality rate at the sixth month in patients with severe kidney injury.

The researchers have confirmed for the first time that applying renal replacement therapy can significantly lower the mortality rate of patients with severe kidney injury after cardiac arrest outside the hospital.

“The mortality rate of patients developing severe acute kidney injury after out-of-hospital cardiac arrest is extremely high,” Professor Oh said. “As renal replacement therapy can lower the CFR, however, doctors should not give up on their patients even when they develop severe acute kidney injury and apply the therapy on them.”

The study was published in the latest issue of Critical Care (Impact Factor: 6.959), a global journal in the intensive care field.

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