Outcomes of renal replacement therapy in acute kidney injury: factors associated with dialysis dependence and progression to end-stage renal disease–a MarketScan database analysis

Objectives: Renal replacement therapy (RRT) is vital for managing acute kidney injury (AKI), with continuous renal replacement therapy (CRRT) and intermittent hemodialysis (iHD) as primary modalities. CRRT is preferred for critically ill patients due to gradual fluid and solute removal, whereas iHD is used for stable patients. Outcomes among AKI patients requiring RRT vary widely, with some recovering kidney function while others progress to end-stage renal disease (ESRD). This study evaluates the risk of dialysis dependence and ESRD within 90 days among AKI patients receiving RRT. Methods: Retrospective cohort study analyzed inpatient admissions from the MarketScan database (2005–2021) with an AKI diagnosis requiring RRT, identified using ICD-10 codes. Logistic regression compared CRRT and iHD groups, adjusting for age, sex, length of stay, and calendar year. Results: Compared to iHD, CRRT was associated with 67% lower odds of dialysis dependence at discharge (OR = 0.33; 95% CI: 0.28–0.39) and 80% lower odds at 90 days (OR = 0.20; 95% CI: 0.16–0.27). Patients receiving both iHD and CRRT had higher odds of dialysis dependence at discharge (OR = 1.41; 95% CI: 1.27–1.57) but 46% lower odds at 90 days (OR = 0.54; 95% CI: 0.45–0.64). CRRT also reduced the risk of ESRD within 90 days by 88% (OR = 0.12; 95% CI: 0.10–0.14). Conclusion: Our study demonstrates that compared to iHD, CRRT is associated with a significantly lower risk of dialysis dependence and progression to ESRD in patients with AKI. CRRT may prevent further kidney injury and promote improved renal recovery.