Timing of Renal Replacement Therapy and its impact on the Outcome of Acute Kidney Injury Patients
Journal Title: The Egyptian Journal of Hospital Medicine - Year 2018, Vol 72, Issue 7
Abstract
<strong>Background: </strong>Previous studies using Acute Kidney Injury Network (AKIN)/RIFLE criteria to classify early initiation of renal replacement therapy (RRT) have defined it as the therapy started in less severe AKIN/RIFLE stages. Generally, these studies failed in demonstrating measurable benefits.<br /> <strong>Aim: </strong>To evaluate RRT in critically ill patients and its timing and its impact on critically ill patients.<br /> <strong>Methods: </strong>We compared RRT initiation in critically ill patients and defined early or late RRT in reference to timing after stage 3 AKIN was met: patients beginning RRT within 24 hours after acute kidney injury (AKI) stage 3 were considered early starters. AKIN criteria were evaluated by both urine output (UO) and serum creatinine (sCr) and patients with acute-on-chronic kidney disease were excluded. A propensity score methodology was used to control variables.<br /> <strong>Results: </strong>A total of 358 critically ill patients were submitted to RRT. Only 150 patients with pure AKI at stage 3 were analyzed. Mortality was lower in the early RRT group (51.5 vs. 77.9%, P = 0.001). After achieving balance between the groups using a propensity score, there was a significant 30.5 (95% confidence interval [CI] 14.4 to 45.2%, P = 0.002) relative decrease of mortality in the early RRT group. Moreover, patients on the early RRT group had lower duration of mechanical ventilation, time on RRT and a trend to lower intensive care unit (ICU) length of stay.<br /> <strong>Conclusions: </strong>For the first time, AKIN was used with UO criterion to evaluate early and late RRT. Using a time based approach could be a better parameter to access the association between RRT initiation and outcomes in patients with AKI.
Authors and Affiliations
Eman Helal
Keywords
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- EP ID EP584267
- DOI 10.12816/ejhm.2018.10180
- Views 93
- Downloads 0
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