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Early initiation of continuous renal replacement therapy improves patient survival in severe progressive septic acute kidney injury

 Hyung Jung Oh  ;  Dong Ho Shin  ;  Mi Jung Lee  ;  Hyang Mo Koo  ;  Fa Mee Doh  ;  Hyoung Rae Kim  ;  Jae Hyun Han  ;  Jung Tak Park  ;  Seung Hyeok Han  ;  Tae-Hyun Yoo  ;  Kyu Hun Choi  ;  Shin-Wook Kang 
 JOURNAL OF CRITICAL CARE, Vol.27(6) : 743-18, 2012 
Journal Title
Issue Date
Acute Kidney Injury/mortality ; Acute Kidney Injury/therapy* ; Age Factors ; Aged ; Comorbidity ; Female ; Health Status Indicators ; Humans ; Intensive Care Units ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Renal Replacement Therapy/methods* ; Retrospective Studies ; Sepsis/mortality ; Sepsis/therapy* ; Sex Factors ; Systemic Inflammatory Response Syndrome/mortality ; Systemic Inflammatory Response Syndrome/therapy ; Time Factors ; Vasoconstrictor Agents/therapeutic use
Sepsis ; Acute kidney injury ; Timing ; Continuous renal replacement therapy ; 28-day mortality
PURPOSE: The definition of "early" in terms of continuous renal replacement therapy (CRRT) initiation has not been uniformly used. Therefore, we tried to elucidate whether the timing of CRRT application, based on the interval between the start time of vasopressors infusion and CRRT initiation, was an independent predictor of mortality in the patients with septic acute kidney injury (AKI). MATERIALS AND METHODS: Progressive septic AKI patients, in whom the infusion doses of vasopressors were increased compared with the initial dose during the first 6 hours of vasopressor treatment and CRRT was performed, between 2009 and 2011, were collected and divided into 2 groups based on the median interval between the 2 points. RESULTS: A total of 210 patients were included. The mean age was 62.4 years, and 126 patients (60.0%) were male. The most common comorbid disease was malignancy (53.8%), followed by hypertension (35.7%) and diabetes mellitus (29.0%). The median interval between the start time of vasopressor infusion and CRRT commencement was 2.0 days. During the study period, 156 patients (74.3%) died within 28 days of CRRT application. The interval between 2 points was significantly shorter in the survivor compared with the death group (P < .001). Moreover, 28-day overall mortality rates in the early CRRT group were significantly lower than those in the late CRRT group (P = .034). Furthermore, early CRRT treatment was independently associated with a lower mortality rate even after adjustment for age, sex, causative organisms, and infection sites (P = .032). CONCLUSIONS: This retrospective cohort study suggests that early initiation of CRRT may be of benefit. Given the complex nature of this intervention, the ongoing controversies regarding early vs late initiation of therapy in acute and chronic situation, there is an urgent need to develop well-designed clinical trials to answer the question definitely.
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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
Koo, Hyang Mo(구향모)
Kim, Hyoung Rae(김형래)
Doh, Fa Mee(도화미) ORCID logo https://orcid.org/0000-0002-4780-6728
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Oh, Hyung Jung(오형중)
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Lee, Mi Jung(이미정)
Choi, Kyu Hun(최규헌) ORCID logo https://orcid.org/0000-0003-0095-9011
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
Han, Jae Hyun(한재현)
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