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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 9/2012

01-09-2012 | Reports of Original Investigations

Timing the initiation of renal replacement therapy for acute kidney injury in Canadian intensive care units: a multicentre observational study

Authors: Edward Clark, MD, Ron Wald, MD, Adeera Levin, MD, Josée Bouchard, MD, Neill K. J. Adhikari, MD, Michelle Hladunewich, MD, Robert M. A. Richardson, MD, Matthew T. James, MD, Michael W. Walsh, MD, Andrew A. House, MD, Louise Moist, MD, Daniel E. Stollery, MD, Karen E. A. Burns, MD, Jan O. Friedrich, MD, James Barton, MD, Jean-Philippe Lafrance, MD, Neesh Pannu, MD, Sean M. Bagshaw, MD, For the Canadian Acute Kidney Injury (CANAKI) Investigators

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 9/2012

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Abstract

Purpose

The optimal timing for starting renal replacement therapy (RRT) in patients with acute kidney injury (AKI) is unknown. Defining current practice is necessary to design interventional trials. We describe the current Canadian practice regarding the timing of RRT initiation for AKI.

Methods

An observational study of patients undergoing RRT for AKI was undertaken at 11 intensive care units (ICUs) across Canada. Data were captured on demographics, clinical and laboratory findings, indications for RRT, and timing of RRT initiation.

Results

Among 119 consecutive patients, the most common ICU admission diagnosis was sepsis/septic shock, occurring in 54%. At the time of RRT initiation, the median and interquartile range (IQR) serum creatinine level was 322 (221-432) μmol·L−1. The mean (SD) values for other parameters were as follows: Sequential Organ Failure Assessment (SOFA) score 13.4 (4.1), pH 7.25 (0.15), potassium 4.6 (1.0) mmol·L−1. Also, 64% fulfilled the serum creatinine-based criterion for Acute Kidney Injury Network (AKIN) stage 3. Severity of illness, measured using Acute Physiology and Chronic Health Evaluation (APACHE II) and SOFA scores, did not correlate with AKI severity as defined by the serum creatinine-based AKIN criteria. Median (IQR) time from hospital and ICU admission to the start of RRT was 2.0 (1.0-7.0) days and 1.0 (0-2.0) day, respectively.

Conclusion

Patients admitted to an ICU who were started on RRT generally had advanced AKI, high-grade illness severity, and multiorgan dysfunction. Also, they were started on RRT shortly after hospital presentation. We describe the current state of practice in Canada regarding the initiation of RRT for AKI in critically ill patients, which can inform the designs of future interventional trials.
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Metadata
Title
Timing the initiation of renal replacement therapy for acute kidney injury in Canadian intensive care units: a multicentre observational study
Authors
Edward Clark, MD
Ron Wald, MD
Adeera Levin, MD
Josée Bouchard, MD
Neill K. J. Adhikari, MD
Michelle Hladunewich, MD
Robert M. A. Richardson, MD
Matthew T. James, MD
Michael W. Walsh, MD
Andrew A. House, MD
Louise Moist, MD
Daniel E. Stollery, MD
Karen E. A. Burns, MD
Jan O. Friedrich, MD
James Barton, MD
Jean-Philippe Lafrance, MD
Neesh Pannu, MD
Sean M. Bagshaw, MD
For the Canadian Acute Kidney Injury (CANAKI) Investigators
Publication date
01-09-2012
Publisher
Springer-Verlag
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 9/2012
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-012-9750-4

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