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Can early initiation of continuous renal replacement therapy improve patient survival with septic acute kidney injury when enrolled in early goal-directed therapy?

 Hyung Jung Oh  ;  Min Hyung Kim  ;  Jin Young Ahn  ;  Nam Su Ku  ;  Jung Tak Park  ;  Sang Hoon Han  ;  Jun Yong Choi  ;  Seung Hyeok Han  ;  Tae-Hyun Yoo  ;  Young Goo Song  ;  Shin-Wook Kang 
 JOURNAL OF CRITICAL CARE, Vol.35 : 51-56, 2016 
Journal Title
Issue Date
APACHE ; Acute Kidney Injury/mortality ; Acute Kidney Injury/therapy* ; Aged ; Cohort Studies ; Critical Care/standards* ; Female ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Quality Improvement ; Renal Replacement Therapy* ; Republic of Korea ; Retrospective Studies ; Sepsis/mortality ; Sepsis/therapy* ; Survival Analysis
28-Day mortality ; AKI ; EGDT ; Early CRRT ; Sepsis
PURPOSE: The purpose of our study was to investigate the timing of continuous renal replacement therapy (CRRT) application, based on the interval between the start of early goal-directed therapy (EGDT) and CRRT initiation, to ascertain whether the timing was an independent predictor of mortality in patients with septic acute kidney injury (AKI).

MATERIALS AND METHODS: An observational retrospective cohort study was conducted of 60 patients (>18 years old) who had been admitted to the emergency department and received resuscitation according to the standard EGDT algorithm for severe sepsis and septic shock, and who were treated with CRRT due to septic AKI, between June 2008 and February 2013 at a tertiary hospital in Seoul, Korea. The patients were divided into 2 groups based on the median interval between the start of EGDT and the commencement of CRRT. The main outcome was 28-day all-cause mortality, and a multivariate Cox analysis for mortality was used to evaluate the independent impact of the early CRRT treatment.

RESULTS: The mean patient age was 66.3 years, and 52 (86.7%) were male. The most common comorbid disease was diabetes mellitus (35.0%) followed by malignancy (26.7%). The median interval between the start of EGDT and commencement of CRRT was 26.4 hours. During the study period, 28-day mortality was 43.3% (26 of 60 patients). The 28-day all-cause mortality rate was significantly higher in the late CRRT group than in the early CRRT group (56.7 vs 30.0%, P= .037). Furthermore, the higher mortality risk in the late group remained significant even after adjusting for diabetes mellitus, liver failure, and Acute Physiology and Chronic Health Evaluation II scores (hazard ratio, 2.461; 95% confidence interval, 1.044-5.800; P= .026).

CONCLUSION: Early initiation of CRRT may be of benefit. Given the complex nature of this intervention and the ongoing controversy regarding early vs late initiation of therapy in acute and chronic situations, it is vital to develop accurate clinical trials to find definitive answers.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Ku, Nam Su(구남수) ORCID logo https://orcid.org/0000-0002-9717-4327
Kim, June Myung(김준명)
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Song, Young Goo(송영구) ORCID logo https://orcid.org/0000-0002-0733-4156
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Choi, Jun Yong(최준용) ORCID logo https://orcid.org/0000-0002-2775-3315
Han, Sang Hoon(한상훈) ORCID logo https://orcid.org/0000-0002-4278-5198
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
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