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Impact of Early Continuous Kidney Replacement Therapy in Patients With Sepsis-Associated Acute Kidney Injury: An Analysis of the MIMIC-IV Database

Authors
 Yongseop Lee  ;  Jun Hye Seo  ;  Jaeeun Seong  ;  Sang Min Ahn  ;  Min Han  ;  Jung Ah Lee  ;  Jung Ho Kim  ;  Jin Young Ahn  ;  Su Jin Jeong  ;  Jun Yong Choi  ;  Joon-Sup Yeom  ;  Hyung Jung Oh  ;  Nam Su Ku 
Citation
 JOURNAL OF KOREAN MEDICAL SCIENCE, Vol.39(43) : e276, 2024-11 
Journal Title
JOURNAL OF KOREAN MEDICAL SCIENCE
ISSN
 1011-8934 
Issue Date
2024-11
MeSH
Acute Kidney Injury* / diagnosis ; Acute Kidney Injury* / etiology ; Acute Kidney Injury* / mortality ; Acute Kidney Injury* / therapy ; Aged ; Continuous Renal Replacement Therapy* ; Databases, Factual* ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Odds Ratio ; Propensity Score ; Renal Replacement Therapy ; Retrospective Studies ; Sepsis* / complications ; Sepsis* / mortality ; Time Factors ; Treatment Outcome
Keywords
Acute Kidney Injury ; Mortality ; Renal Replacement Therapy ; Sepsis
Abstract
Background: Renal replacement therapy (RRT) is an important treatment option for sepsis-associated acute kidney injury (AKI); however, the optimal timing for its initiation remains controversial. Herein, we investigated the clinical outcomes of early continuous kidney replacement therapy (CKRT), defined as CKRT initiation within 6 hours of sepsis-associated AKI onset, which was earlier than the initiation time defined in previous studies.

Methods: We used clinical data sourced from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. This study included patients aged ≥ 18 years who met the sepsis diagnostic criteria and received CKRT because of stage 2 or 3 AKI. Early and late CKRTs were defined as CKRT initiation within 6 hours and after 6 hours of the development of sepsis-associated AKI, respectively.

Results: Of the 33,236 patients diagnosed with sepsis, 553 underwent CKRT for sepsis-associated AKI. After excluding cases of early mortality and patients with a dialysis history, 45 and 334 patients were included in the early and late CKRT groups, respectively. After propensity score matching, the 28-day mortality rate was significantly lower in the early CKRT group than in the late CKRT group (26.7% vs. 43.9%, P = 0.035). The early CKRT group also had a significantly greater number of days free of mechanical ventilation (median, 19; interquartile range [IQR], 3-25) and vasopressor administration (median, 21; IQR, 5-26) than the late CKRT group did (median, 10.5; IQR, 0-23; P = 0.037 and median, 13.5; IQR, 0-25; P = 0.028, respectively). The Kaplan-Meier curve also showed that early CKRT initiation was associated with an improved 28-day mortality rate (log-rank test, P = 0.040). In contrast, there was no significant difference in the 28-day mortality between patients who started CKRT within 12 hours and those who did not (log-rank test, P = 0.237).

Conclusion: Early CKRT initiation improved the survival of patients with sepsis-associated AKI. Initiation of CKRT should be considered as early as possible after sepsis-associated AKI onset, preferably within 6 hours.
Files in This Item:
T202407136.pdf Download
DOI
10.3346/jkms.2024.39.e276
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ku, Nam Su(구남수) ORCID logo https://orcid.org/0000-0002-9717-4327
Kim, Jung Ho(김정호) ORCID logo https://orcid.org/0000-0002-5033-3482
Seong, Jaeeun(성재은)
Ahn, Sang Min(안상민)
Ahn, Jin Young(안진영) ORCID logo https://orcid.org/0000-0002-3740-2826
Yeom, Joon Sup(염준섭) ORCID logo https://orcid.org/0000-0001-8940-7170
Lee, Yongseop(이용섭)
Lee, Jung Ah(이정아)
Jeong, Su Jin(정수진) ORCID logo https://orcid.org/0000-0003-4025-4542
Choi, Jun Yong(최준용) ORCID logo https://orcid.org/0000-0002-2775-3315
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/201403
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