Risk factors of early redialysis after weaning from postoperative acute renal replacement therapy.
OBJECTIVE
The aim of this study was to identify risk factors for redialysis in postoperative patients with acute renal failure (ARF) who had previously been weaned from acute dialysis. Although recovery of renal function is anticipated in patients with ARF, no data have been reported on successful weaning from acute dialysis.


METHODS
Retrospective observational case-control study in a 64-bed surgical ICU.


METHODS
Success in discontinuing dialysis was defined as cessation from dialysis for at least 30 days. A total of 304 postoperative patients who underwent acute renal replacement therapy in a surgical ICU between July 2002 and April 2005 were included. SOFA score biochemical data and renal function parameters were assessed on the day after the last session of renal replacement therapy, designated as day 0 (D0).


RESULTS
We could wean 94 patients (30.9%) from acute dialysis for more than 5 days, and 64 of these (21.1%) were successfully weaned for at least 30days. The independent predictors for resuming dialysis within 30 days were: (a) longer duration of dialysis (OR 1.06), (b) higher SOFA score on D0 (OR 1.44), (c) oliguria (urine output <100cc/8h; OR 4.17) on D1, and (d) age over 65 years (OR 6.35). The area under the ROC curve was 0.880. Two-way analysis of variance with repeated measurements over time showed a larger decline in SOFA score and an increase in urine output in patients with successful cessation of dialysis. Kaplan-Meier analysis showed a significant difference in early resumption of dialysis between patients with or without oliguria at D0.


CONCLUSIONS
More than two-thirds of patients weaned from postoperative acute dialysis for more than 5 days were free of dialysis for at least 30 days. Less urine output, longer duration of dialysis, age over 65 years, and higher disease severity score are predictive of a patient's redialysis after initial weaning from acute dialysis.
Wu
Vin-Cent
VC
Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan.
Ko
Wen-Je
WJ
Chang
Hong-Wei
HW
Chen
Yung-Wei
YW
Lin
Yu-Feng
YF
Shiao
Chih-Chung
CC
Chen
Yung-Ming
YM
Chen
Yih-Sharng
YS
Tsai
Pi-Ru
PR
Hu
Fu-Chang
FC
Wang
Jann-Yuan
JY
Lin
Yen-Hung
YH
Wu
Kwan-Dun
KD
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D012307:Risk Factors; D014886:Weaning
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