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Does early initiation of continuous renal replacement therapy affect outcome: experience in a tertiary care center.
Ren Fail. 2011; 33(7):698-706.RF

Abstract

BACKGROUND

Acute kidney injury (AKI) requiring dialysis commonly occurs in critically ill patients and is associated with high mortality. Factors impacting outcomes of individuals with AKI who underwent continuous renal replacement therapy (CRRT), including early versus late initiation and duration of CRRT, were examined.

METHODS

Survival and recovery of renal function for patients with AKI in the intensive care unit were retrospectively examined over a 7-year period. Factors associated with mortality and renal recovery were analyzed based on severity of illness as defined by Cleveland Clinic Foundation (CCF) score. Univariate and multivariate logistic regression analysis with backward elimination was performed to determine the most significant risk factors.

RESULTS

Of patients who underwent CRRT, 230/330 met inclusion criteria. During index admission 112/230 (48.7%) patients died. Median survival was 15.5 days [95% confidence interval (12.0, 18.0)]. Among survivors, renal recovery occurred in 84/118 (71.2%). Renal recovery overall was observed in 90/230 subjects (39.13%). A higher baseline CCF score correlated with higher mortality and lower probability of renal recovery. Patients initiated on CRRT > 6 days after AKI diagnosis had significantly higher mortality compared with those initiated earlier (odds ratio = 11.66, p = 0.0305). Patients receiving CRRT >10 days had a higher mortality rate compared with those with shorter exposure (71.3% vs. 45.5%, respectively, p = 0.012).

CONCLUSIONS

CRRT remains an important dialysis modality in hemodynamically unstable patients with AKI. Mortality in these patients continues to be high. Renal recovery is high in survivors. Delay in initiation and length of CRRT exposure may portend poorer prognosis.

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Authors+Show Affiliations

Vats HS
Department of Internal Medicine, Marshfield Clinic Marshfield, Marshfield, WI 52713, USA. hvats@uwhealth.org
Dart RA
No affiliation info available
Okon TR
No affiliation info available
Liang H
No affiliation info available
Paganini EP
No affiliation info available

MeSH

Acute Kidney InjuryAgedFemaleHumansMaleRenal DialysisRenal Replacement TherapyRetrospective StudiesTime FactorsTreatment Outcome

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21787161

Citation

Vats, Hemender S., et al. "Does Early Initiation of Continuous Renal Replacement Therapy Affect Outcome: Experience in a Tertiary Care Center." Renal Failure, vol. 33, no. 7, 2011, pp. 698-706.
Vats HS, Dart RA, Okon TR, et al. Does early initiation of continuous renal replacement therapy affect outcome: experience in a tertiary care center. Ren Fail. 2011;33(7):698-706.
Vats, H. S., Dart, R. A., Okon, T. R., Liang, H., & Paganini, E. P. (2011). Does early initiation of continuous renal replacement therapy affect outcome: experience in a tertiary care center. Renal Failure, 33(7), 698-706. https://doi.org/10.3109/0886022X.2011.589945
Vats HS, et al. Does Early Initiation of Continuous Renal Replacement Therapy Affect Outcome: Experience in a Tertiary Care Center. Ren Fail. 2011;33(7):698-706. PubMed PMID: 21787161.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does early initiation of continuous renal replacement therapy affect outcome: experience in a tertiary care center. AU - Vats,Hemender S, AU - Dart,Richard A, AU - Okon,Tomasz R, AU - Liang,Hong, AU - Paganini,Emil P, PY - 2011/7/27/entrez PY - 2011/7/27/pubmed PY - 2011/12/13/medline SP - 698 EP - 706 JF - Renal failure JO - Ren Fail VL - 33 IS - 7 N2 - BACKGROUND: Acute kidney injury (AKI) requiring dialysis commonly occurs in critically ill patients and is associated with high mortality. Factors impacting outcomes of individuals with AKI who underwent continuous renal replacement therapy (CRRT), including early versus late initiation and duration of CRRT, were examined. METHODS: Survival and recovery of renal function for patients with AKI in the intensive care unit were retrospectively examined over a 7-year period. Factors associated with mortality and renal recovery were analyzed based on severity of illness as defined by Cleveland Clinic Foundation (CCF) score. Univariate and multivariate logistic regression analysis with backward elimination was performed to determine the most significant risk factors. RESULTS: Of patients who underwent CRRT, 230/330 met inclusion criteria. During index admission 112/230 (48.7%) patients died. Median survival was 15.5 days [95% confidence interval (12.0, 18.0)]. Among survivors, renal recovery occurred in 84/118 (71.2%). Renal recovery overall was observed in 90/230 subjects (39.13%). A higher baseline CCF score correlated with higher mortality and lower probability of renal recovery. Patients initiated on CRRT > 6 days after AKI diagnosis had significantly higher mortality compared with those initiated earlier (odds ratio = 11.66, p = 0.0305). Patients receiving CRRT >10 days had a higher mortality rate compared with those with shorter exposure (71.3% vs. 45.5%, respectively, p = 0.012). CONCLUSIONS: CRRT remains an important dialysis modality in hemodynamically unstable patients with AKI. Mortality in these patients continues to be high. Renal recovery is high in survivors. Delay in initiation and length of CRRT exposure may portend poorer prognosis. SN - 1525-6049 UR - https://www.unboundmedicine.com/medline/citation/21787161/Does_early_initiation_of_continuous_renal_replacement_therapy_affect_outcome:_experience_in_a_tertiary_care_center_ L2 - https://www.tandfonline.com/doi/full/10.3109/0886022X.2011.589945 DB - PRIME DP - Unbound Medicine ER -
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