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Critical Care
Published in: Critical Care 5/2009

Open Access 01-10-2009 | Research

Late initiation of renal replacement therapy is associated with worse outcomes in acute kidney injury after major abdominal surgery

Authors: Chih-Chung Shiao, Vin-Cent Wu, Wen-Yi Li, Yu-Feng Lin, Fu-Chang Hu, Guang-Huar Young, Chin-Chi Kuo, Tze-Wah Kao, Down-Ming Huang, Yung-Ming Chen, Pi-Ru Tsai, Shuei-Liong Lin, Nai-Kuan Chou, Tzu-Hsin Lin, Yu-Chang Yeh, Chih-Hsien Wang, Anne Chou, Wen-Je Ko, Kwan-Dun Wu, the National Taiwan University Surgical Intensive Care Unit-Associated Renal Failure (NSARF) Study Group

Published in: Critical Care | Issue 5/2009

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Abstract

Introduction

Abdominal surgery is probably associated with more likelihood to cause acute kidney injury (AKI). The aim of this study was to evaluate whether early or late start of renal replacement therapy (RRT) defined by simplified RIFLE (sRIFLE) classification in AKI patients after major abdominal surgery will affect outcome.

Methods

A multicenter prospective observational study based on the NSARF (N ational Taiwan University S urgical ICU A ssociated R enal F ailure) Study Group database. 98 patients (41 female, mean age 66.4 ± 13.9 years) who underwent acute RRT according to local indications for post-major abdominal surgery AKI between 1 January, 2002 and 31 December, 2005 were enrolled The demographic data, comorbid diseases, types of surgery and RRT, as well as the indications for RRT were documented. The patients were divided into early dialysis (sRIFLE-0 or Risk) and late dialysis (LD, sRIFLE -Injury or Failure) groups. Then we measured and recorded patients' outcome including in-hospital mortality and RRT wean-off until 30 June, 2006.

Results

The in-hospital mortality was compared as endpoint. Fifty-seven patients (58.2%) died during hospitalization. LD (hazard ratio (HR) 1.846; P = 0.027), old age (HR 2.090; P = 0.010), cardiac failure (HR 4.620; P < 0.001), pre-RRT SOFA score (HR 1.152; P < 0.001) were independent indicators for in-hospital mortality.

Conclusions

The findings of this study support earlier initiation of acute RRT, and also underscore the importance of predicting prognoses of major abdominal surgical patients with AKI by using RIFLE classification.
Appendix
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Metadata
Title
Late initiation of renal replacement therapy is associated with worse outcomes in acute kidney injury after major abdominal surgery
Authors
Chih-Chung Shiao
Vin-Cent Wu
Wen-Yi Li
Yu-Feng Lin
Fu-Chang Hu
Guang-Huar Young
Chin-Chi Kuo
Tze-Wah Kao
Down-Ming Huang
Yung-Ming Chen
Pi-Ru Tsai
Shuei-Liong Lin
Nai-Kuan Chou
Tzu-Hsin Lin
Yu-Chang Yeh
Chih-Hsien Wang
Anne Chou
Wen-Je Ko
Kwan-Dun Wu
the National Taiwan University Surgical Intensive Care Unit-Associated Renal Failure (NSARF) Study Group
Publication date
01-10-2009
Publisher
BioMed Central
Published in
Critical Care / Issue 5/2009
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc8147

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