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Severe acute kidney injury not treated with renal replacement therapy: characteristics and outcome.
Nephrol Dial Transplant. 2012 Mar; 27(3):947-52.ND

Abstract

BACKGROUND

Only a proportion of critically ill patients with severe [RIFLE (Risk, Injury, Failure, Loss, End-stage renal disease) criteria, class-F] acute kidney injury (AKI) appear to receive renal replacement therapy (RRT). The aim of this study was to study the characteristics and outcome of patients with severe (RIFLE-F) AKI who did not receive RRT.

METHODS

We identified all consecutive patients admitted to our institution that developed RIFLE-F AKI by creatinine criteria over a 3-year period and did not receive RRT, and compared their characteristics and outcomes with those of RIFLE-F RRT-treated patients.

RESULTS

Within the study period, 20,126 patients were admitted to our institution for >24 h. Among them, 2949 were admitted to the intensive care unit (ICU) and 195 developed RIFLE-F AKI. Of these, 90 received RRT (RRT patients) and 105 did not (no-RRT patients). Compared with RRT patients, no-RRT patients were similar in terms of age, gender and ward of origin. However, they had a shorter median ICU stay (2.7 versus 7.9 days; P < 0.001), required less mechanical ventilation (56.2 versus 70%; P < 0.05) and had a lower mean Acute Physiology and Chronic Health Evaluation III score (82.7 versus 86.7; P < 0.05). The two main reasons these patients did not receive RRT were limitations of medical therapy (LOMT) orders in 41 (39%) cases and expected renal functional improvement in 59 (56.2%). Mortality in no-RRT patients was 58.1% compared with 55.5% in the RRT group (P = 0.72). After exclusion of LOMT patients, the mortality of the no-RRT group, although lower than that of the RRT group, remained high (30.5 versus 55%; P < 0.001). Most of these deaths occurred after ICU discharge and appeared secondary to underlying chronic diseases or recurrence of the initial insult.

CONCLUSIONS

After exclusion of LOMT patients, about a third of critically ill patients with severe (RIFLE-F) AKI did not receive RRT. A third of these patients died in hospital. The timing of the deaths and their underlying causes do not suggest that a broader application of RRT would have changed patient outcomes.

Authors+Show Affiliations

Department of Intensive Care, Austin Health, Heidelberg, Australia.No affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

21908413

Citation

Schneider, Antoine G., et al. "Severe Acute Kidney Injury Not Treated With Renal Replacement Therapy: Characteristics and Outcome." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 27, no. 3, 2012, pp. 947-52.
Schneider AG, Uchino S, Bellomo R. Severe acute kidney injury not treated with renal replacement therapy: characteristics and outcome. Nephrol Dial Transplant. 2012;27(3):947-52.
Schneider, A. G., Uchino, S., & Bellomo, R. (2012). Severe acute kidney injury not treated with renal replacement therapy: characteristics and outcome. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 27(3), 947-52. https://doi.org/10.1093/ndt/gfr501
Schneider AG, Uchino S, Bellomo R. Severe Acute Kidney Injury Not Treated With Renal Replacement Therapy: Characteristics and Outcome. Nephrol Dial Transplant. 2012;27(3):947-52. PubMed PMID: 21908413.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Severe acute kidney injury not treated with renal replacement therapy: characteristics and outcome. AU - Schneider,Antoine G, AU - Uchino,Shigehiko, AU - Bellomo,Rinaldo, Y1 - 2011/09/08/ PY - 2011/9/13/entrez PY - 2011/9/13/pubmed PY - 2012/9/15/medline SP - 947 EP - 52 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 27 IS - 3 N2 - BACKGROUND: Only a proportion of critically ill patients with severe [RIFLE (Risk, Injury, Failure, Loss, End-stage renal disease) criteria, class-F] acute kidney injury (AKI) appear to receive renal replacement therapy (RRT). The aim of this study was to study the characteristics and outcome of patients with severe (RIFLE-F) AKI who did not receive RRT. METHODS: We identified all consecutive patients admitted to our institution that developed RIFLE-F AKI by creatinine criteria over a 3-year period and did not receive RRT, and compared their characteristics and outcomes with those of RIFLE-F RRT-treated patients. RESULTS: Within the study period, 20,126 patients were admitted to our institution for >24 h. Among them, 2949 were admitted to the intensive care unit (ICU) and 195 developed RIFLE-F AKI. Of these, 90 received RRT (RRT patients) and 105 did not (no-RRT patients). Compared with RRT patients, no-RRT patients were similar in terms of age, gender and ward of origin. However, they had a shorter median ICU stay (2.7 versus 7.9 days; P < 0.001), required less mechanical ventilation (56.2 versus 70%; P < 0.05) and had a lower mean Acute Physiology and Chronic Health Evaluation III score (82.7 versus 86.7; P < 0.05). The two main reasons these patients did not receive RRT were limitations of medical therapy (LOMT) orders in 41 (39%) cases and expected renal functional improvement in 59 (56.2%). Mortality in no-RRT patients was 58.1% compared with 55.5% in the RRT group (P = 0.72). After exclusion of LOMT patients, the mortality of the no-RRT group, although lower than that of the RRT group, remained high (30.5 versus 55%; P < 0.001). Most of these deaths occurred after ICU discharge and appeared secondary to underlying chronic diseases or recurrence of the initial insult. CONCLUSIONS: After exclusion of LOMT patients, about a third of critically ill patients with severe (RIFLE-F) AKI did not receive RRT. A third of these patients died in hospital. The timing of the deaths and their underlying causes do not suggest that a broader application of RRT would have changed patient outcomes. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/21908413/Severe_acute_kidney_injury_not_treated_with_renal_replacement_therapy:_characteristics_and_outcome_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfr501 DB - PRIME DP - Unbound Medicine ER -