2026/03/16 by Hidehiko Nakano, Ryohei Horie, Takashi Gondo +3 · 1 voice
Medicine · Nursing · #Acute Kidney Injury Research #Clinical Nutrition and Gastroenterology #Methemoglobinemia and Tumor Lysis Syndrome
paper · doi:10.1016/j.jcrc.2026.155522
openalex publication_date 2026/03/16 · openalex created_date 2026/03/17 · openalex updated_date 2026/06/18
PURPOSE: Investigate the association between the phenotypic classification of laboratory data and mortality in adult patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT). METHODS: This post-hoc analysis of a retrospective multicenter cohort study examined adult AKI patients treated with CRRT at 18 university hospitals in Japan. The primary outcome was mortality within 7 days of CRRT termination. The phenotypes were classified by analyzing the laboratory data until day 3 following CRRT initiation using a group-based multitrajectory (GBMT) analysis. External validation was performed using the Medical Information Mart for Intensive Care (MIMIC)-IV database. RESULTS: Altogether, 550 patients were categorized into the following three groups based on their lactate (Lac) levels and serum urea nitrogen-to-creatinine ratio (UCR): group 1, high Lac levels; group 2, high UCR; and group 3, normal UCR and Lac levels. Groups 1 and 2 exhibited higher mortality rates than group 3 (33.3% vs. 29.3% vs. 13.5%, p < 0.01), although group 3 demonstrated the highest serum creatinine level (2.3 vs. 2.1 vs. 3.0 mg/dL, p < 0.001). External validation using the MIMIC-IV database showed similar results. CONCLUSIONS: UCR and Lac were distinctive factors in the GBMT analysis. The groups with high UCR or high Lac levels had significantly higher mortality rates than the groups with normal UCR and Lac levels. UCR may reflect increased protein metabolism and be a useful risk factor for mortality even in patients with severe AKI requiring CRRT.