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Critical Care
Published in: Critical Care 3/2011

Open Access 01-06-2011 | Research

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

Authors: Yu-Hsiang Chou, Tao-Min Huang, Vin-Cent Wu, Cheng-Yi Wang, Chih-Chung Shiao, Chun-Fu Lai, Hung-Bin Tsai, Chia-Ter Chao, Guang-Huar Young, Wei-Jei Wang, Tze-Wah Kao, Shuei-Liong Lin, Yin-Yi Han, Anne Chou, Tzu-Hsin Lin, Ya-Wen Yang, Yung-Ming Chen, Pi-Ru Tsai, Yu-Feng Lin, Jenq-Wen Huang, Wen-Chih Chiang, Nai-Kuan Chou, Wen-Je Ko, Kwan-Dun Wu, Tun-Jun Tsai, the NSARF Study Group

Published in: Critical Care | Issue 3/2011

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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.
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Metadata
Title
Impact of timing of renal replacement therapy initiation on outcome of septic acute kidney injury
Authors
Yu-Hsiang Chou
Tao-Min Huang
Vin-Cent Wu
Cheng-Yi Wang
Chih-Chung Shiao
Chun-Fu Lai
Hung-Bin Tsai
Chia-Ter Chao
Guang-Huar Young
Wei-Jei Wang
Tze-Wah Kao
Shuei-Liong Lin
Yin-Yi Han
Anne Chou
Tzu-Hsin Lin
Ya-Wen Yang
Yung-Ming Chen
Pi-Ru Tsai
Yu-Feng Lin
Jenq-Wen Huang
Wen-Chih Chiang
Nai-Kuan Chou
Wen-Je Ko
Kwan-Dun Wu
Tun-Jun Tsai
the NSARF Study Group
Publication date
01-06-2011
Publisher
BioMed Central
Published in
Critical Care / Issue 3/2011
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc10252

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