title: Late initiation of renal replacement therapy is associated with worse outcomes in acute kidney injury after major abdominal surgery.
abstract: BACKGROUND
  Abdominal surgery is probably associated with more likelihood to cause acute kidney injury (AKI). The aim of this study was to evaluate whether early or late start of renal replacement therapy (RRT) defined by simplified RIFLE (sRIFLE) classification in AKI patients after major abdominal surgery will affect outcome.
  
  
  METHODS
  A multicenter prospective observational study based on the NSARF (National Taiwan University Surgical ICU Associated Renal Failure) Study Group database. 98 patients (41 female, mean age 66.4 +/- 13.9 years) who underwent acute RRT according to local indications for post-major abdominal surgery AKI between 1 January, 2002 and 31 December, 2005 were enrolled The demographic data, comorbid diseases, types of surgery and RRT, as well as the indications for RRT were documented. The patients were divided into early dialysis (sRIFLE-0 or Risk) and late dialysis (LD, sRIFLE -Injury or Failure) groups. Then we measured and recorded patients' outcome including in-hospital mortality and RRT wean-off until 30 June, 2006.
  
  
  RESULTS
  The in-hospital mortality was compared as endpoint. Fifty-seven patients (58.2%) died during hospitalization. LD (hazard ratio (HR) 1.846; P = 0.027), old age (HR 2.090; P = 0.010), cardiac failure (HR 4.620; P < 0.001), pre-RRT SOFA score (HR 1.152; P < 0.001) were independent indicators for in-hospital mortality.
  
  
  CONCLUSIONS
  The findings of this study support earlier initiation of acute RRT, and also underscore the importance of predicting prognoses of major abdominal surgical patients with AKI by using RIFLE classification.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Saint Mary's Hospital, 160 Chong-Cheng South Road, Lotung 265, I-Lan, Taiwan. chungyy2001@yahoo.com.tw
authors.forename: Chih-Chung
authors.initials: CC
authors.lastname: Shiao
authors.forename: Vin-Cent
authors.initials: VC
authors.lastname: Wu
authors.forename: Wen-Yi
authors.initials: WY
authors.lastname: Li
authors.forename: Yu-Feng
authors.initials: YF
authors.lastname: Lin
authors.forename: Fu-Chang
authors.initials: FC
authors.lastname: Hu
authors.forename: Guang-Huar
authors.initials: GH
authors.lastname: Young
authors.forename: Chin-Chi
authors.initials: CC
authors.lastname: Kuo
authors.forename: Tze-Wah
authors.initials: TW
authors.lastname: Kao
authors.forename: Down-Ming
authors.initials: DM
authors.lastname: Huang
authors.forename: Yung-Ming
authors.initials: YM
authors.lastname: Chen
authors.forename: Pi-Ru
authors.initials: PR
authors.lastname: Tsai
authors.forename: Shuei-Liong
authors.initials: SL
authors.lastname: Lin
authors.forename: Nai-Kuan
authors.initials: NK
authors.lastname: Chou
authors.forename: Tzu-Hsin
authors.initials: TH
authors.lastname: Lin
authors.forename: Yu-Chang
authors.initials: YC
authors.lastname: Yeh
authors.forename: Chih-Hsien
authors.initials: CH
authors.lastname: Wang
authors.forename: Anne
authors.initials: A
authors.lastname: Chou
authors.forename: Wen-Je
authors.initials: WJ
authors.lastname: Ko
authors.forename: Kwan-Dun
authors.initials: KD
authors.lastname: Wu
mesh_terms: D000005:Abdomen / Q000601:surgery*; D058186:Acute Kidney Injury / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D042241:Early Diagnosis; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019370:Observation; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017582:Renal Replacement Therapy; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome