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Early initiation of continuous renal replacement therapy improves survival of elderly patients with acute kidney injury: a multicenter prospective cohort study

Authors
 Jae Yoon Park  ;  Jung Nam An  ;  Jong Hyun Jhee  ;  Dong Ki Kim  ;  Hyung Jung Oh  ;  Sejoong Kim  ;  Kwon Wook Joo  ;  Yun Kyu Oh  ;  Chun-Soo Lim  ;  Shin-Wook Kang  ;  Yon Su Kim  ;  Jung Tak Park  ;  Jung Pyo Lee 
Citation
 Critical Care, Vol.20(1) : 260, 2016 
Journal Title
 Critical Care 
ISSN
 1364-8535 
Issue Date
2016
MeSH
APACHE ; Acute Kidney Injury/epidemiology ; Acute Kidney Injury/therapy* ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; Cohort Studies ; Critical Illness/epidemiology ; Critical Illness/mortality* ; Female ; Humans ; Male ; Prognosis ; Propensity Score ; Prospective Studies ; Regression Analysis ; Renal Replacement Therapy/methods* ; Renal Replacement Therapy/standards ; Republic of Korea/epidemiology ; Survival Analysis ; Time Factors*
Keywords
Acute kidney injury ; Continuous renal replacement therapy ; Elderly patients ; Propensity score matching ; Survival
Abstract
BACKGROUND: Continuous renal replacement therapy (CRRT) is essential in the management of critically ill patients with acute kidney injury (AKI). However, the optimal timing for initiating CRRT remains controversial, especially in elderly patients. Therefore, we investigated the outcomes of early CRRT initiation in elderly patients with AKI. METHODS: A total of 607 patients ≥65 years of age who started CRRT due to AKI between August 2009 and December 2013 were prospectively enrolled. They were divided into two groups based on the median 6-hour urine output immediately before CRRT initiation. Propensity score matching was used to compare the overall survival rate, CRRT duration, and hospitalization duration. RESULTS: The median age of both groups was 73.0 years, and 60 % of the patients were male. The most common cause of AKI was sepsis. In the early CRRT group, the mean arterial pressure was higher, but the prothrombin time and total bilirubin, aspartate aminotransferase, and alanine aminotransferase levels were lower. The overall cumulative survival rate was higher in the early CRRT group (log-rank P?<?0.01). Late CRRT initiation was associated with a higher mortality rate than early initiation after adjusting for age, sex, the Charlson comorbidity index, systolic arterial pressure, prothrombin time, the total bilirubin, aspartate aminotransferase, and alanine aminotransferase levels, cumulative fluid balance and diuretic use (hazard ratio, 1.35; 95 % confidence interval 1.06, 1.71, P?=?0.02). Following propensity score matching, patient survival was significantly better in the early CRRT group than in the late CRRT group (P?<?0.01). The total duration of hospitalization from the start of CRRT was shorter among the survivors when CRRT was started earlier (26.7 versus 39.1 days, P?=?0.04). CONCLUSION: A better prognosis can be expected if CRRT is applied early in the course of AKI in critically ill, elderly patients.
Files in This Item:
T201603090.pdf Download
DOI
10.1186/s13054-016-1437-8
Appears in Collections:
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
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Jhee, Jong Hyun(지종현)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/151901
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