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Open Access 01-04-2013 | Research

Timing of renal replacement therapy initiation by AKIN classification system

Authors: Tacyano T Leite, Etienne Macedo, Samuel M Pereira, Sandro RC Bandeira, Pedro HS Pontes, André S Garcia, Fernanda R Militão, Irineu MM Sobrinho, Livia M Assunção, Alexandre B Libório

Published in: Critical Care | Issue 2/2013

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusions

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.

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Title: Timing of renal replacement therapy initiation by AKIN classification system
Authors: Tacyano T Leite
Etienne Macedo
Samuel M Pereira
Sandro RC Bandeira
Pedro HS Pontes
André S Garcia
Fernanda R Militão
Irineu MM Sobrinho
Livia M Assunção
Alexandre B Libório
Publication date: 01-04-2013
Publisher: BioMed Central
Published in: Critical Care / Issue 2/2013
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc12593

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Springer Medicine

Timing of renal replacement therapy initiation by AKIN classification system

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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