title: Does early initiation of continuous renal replacement therapy affect outcome: experience in a tertiary care center.
abstract: BACKGROUND
  Acute kidney injury (AKI) requiring dialysis commonly occurs in critically ill patients and is associated with high mortality. Factors impacting outcomes of individuals with AKI who underwent continuous renal replacement therapy (CRRT), including early versus late initiation and duration of CRRT, were examined.
  
  
  METHODS
  Survival and recovery of renal function for patients with AKI in the intensive care unit were retrospectively examined over a 7-year period. Factors associated with mortality and renal recovery were analyzed based on severity of illness as defined by Cleveland Clinic Foundation (CCF) score. Univariate and multivariate logistic regression analysis with backward elimination was performed to determine the most significant risk factors.
  
  
  RESULTS
  Of patients who underwent CRRT, 230/330 met inclusion criteria. During index admission 112/230 (48.7%) patients died. Median survival was 15.5 days [95% confidence interval (12.0, 18.0)]. Among survivors, renal recovery occurred in 84/118 (71.2%). Renal recovery overall was observed in 90/230 subjects (39.13%). A higher baseline CCF score correlated with higher mortality and lower probability of renal recovery. Patients initiated on CRRT > 6 days after AKI diagnosis had significantly higher mortality compared with those initiated earlier (odds ratio = 11.66, p = 0.0305). Patients receiving CRRT >10 days had a higher mortality rate compared with those with shorter exposure (71.3% vs. 45.5%, respectively, p = 0.012).
  
  
  CONCLUSIONS
  CRRT remains an important dialysis modality in hemodynamically unstable patients with AKI. Mortality in these patients continues to be high. Renal recovery is high in survivors. Delay in initiation and length of CRRT exposure may portend poorer prognosis.
authors.affiliation: Department of Internal Medicine, Marshfield Clinic Marshfield, Marshfield, WI 52713, USA. hvats@uwhealth.org
authors.forename: Hemender S
authors.initials: HS
authors.lastname: Vats
authors.forename: Richard A
authors.initials: RA
authors.lastname: Dart
authors.forename: Tomasz R
authors.initials: TR
authors.lastname: Okon
authors.forename: Hong
authors.initials: H
authors.lastname: Liang
authors.forename: Emil P
authors.initials: EP
authors.lastname: Paganini
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D006435:Renal Dialysis / Q000379:methods*; D017582:Renal Replacement Therapy / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome