NDLI: Impact of timing of renal replacement therapy initiation on outcome of septic acute kidney injury

Content Provider	Springer Nature : BioMed Central
Author	Chou, Yu-Hsiang Huang, Tao-Min Wu, Vin-Cent Wang, Cheng-Yi Shiao, Chih-Chung Lai, Chun-Fu Tsai, Hung-Bin Chao, Chia-Ter Young, Guang-Huar Wang, Wei-Jei Kao, Tze-Wah Lin, Shuei-Liong Han, Yin-Yi Chou, Anne Lin, Tzu-Hsin Yang, Ya-Wen Chen, Yung-Ming Tsai, Pi-Ru Lin, Yu-Feng Huang, Jenq-Wen Chiang, Wen-Chih Chou, Nai-Kuan Ko, Wen-Je Wu, Kwan-Dun Tsai, Tun-Jun
Abstract	Introduction Sepsis is the leading cause of acute kidney injury (AKI) in critical patients. The optimal timing of initiating renal replacement therapy (RRT) in septic AKI patients remains controversial. The objective of this study is to determine the impact of early or late initiation of RRT, as defined using the simplified RIFLE (risk, injury, failure, loss of kidney function, and end-stage renal failure) classification (sRIFLE), on hospital mortality among septic AKI patients. Methods Patient with sepsis and AKI requiring RRT in surgical intensive care units were enrolled between January 2002 and October 2009. The patients were divided into early (sRIFLE-0 or -Risk) or late (sRIFLE-Injury or -Failure) initiation of RRT by sRIFLE criteria. Cox proportional hazard ratios for in hospital mortality were determined to assess the impact of timing of RRT. Results Among the 370 patients, 192 (51.9%) underwent early RRT and 259 (70.0%) died during hospitalization. The mortality rate in early and late RRT groups were 70.8% and 69.7% respectively (P > 0.05). Early dialysis did not relate to hospital mortality by Cox proportional hazard model (P > 0.05). Patients with heart failure, male gender, higher admission creatinine, and operation were more likely to be in the late RRT group. Cox proportional hazard model, after adjustment with propensity score including all patients based on the probability of late RRT, showed early dialysis was not related to hospital mortality. Further model matched patients by 1:1 fashion according to each patient's propensity to late RRT showed no differences in hospital mortality according to head-to-head comparison of demographic data (P > 0.05). Conclusions Use of sRIFLE classification as a marker poorly predicted the benefits of early or late RRT in the context of septic AKI. In the future, more physiologically meaningful markers with which to determine the optimal timing of RRT initiation should be identified.
Related Links	https://ccforum.biomedcentral.com/counter/pdf/10.1186/cc10252.pdf
Ending Page	9
Page Count	9
Starting Page	1
File Format	HTM / HTML
ISSN	13648535
DOI	10.1186/cc10252
Journal	Critical Care
Issue Number	3
Volume Number	15
Language	English
Publisher	BioMed Central
Publisher Date	2011-06-06
Access Restriction	Open
Subject Keyword	Intensive Critical Care Medicine Emergency Medicine Propensity Score Renal Replacement Therapy Acute Kidney Injury Sequential Organ Failure Assessment Score Acute Kidney Injury Patient
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine
Journal Impact Factor	8.8/2023
5-Year Journal Impact Factor	10.4/2023

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