Late initiation of renal replacement therapy is associated with worse outcomes in acute kidney injury after major abdominal surgery.
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.
Shiao
Chih-Chung
CC
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
Wu
Vin-Cent
VC
Li
Wen-Yi
WY
Lin
Yu-Feng
YF
Hu
Fu-Chang
FC
Young
Guang-Huar
GH
Kuo
Chin-Chi
CC
Kao
Tze-Wah
TW
Huang
Down-Ming
DM
Chen
Yung-Ming
YM
Tsai
Pi-Ru
PR
Lin
Shuei-Liong
SL
Chou
Nai-Kuan
NK
Lin
Tzu-Hsin
TH
Yeh
Yu-Chang
YC
Wang
Chih-Hsien
CH
Chou
Anne
A
Ko
Wen-Je
WJ
Wu
Kwan-Dun
KD
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