title: Late initiation of continuous veno-venous hemofiltration therapy is associated with a lower survival rate in surgical critically ill patients with postoperative acute kidney injury.
abstract: There is controversy about the appropriate timing for renal replacement therapy in patients with acute kidney injury (AKI). We are interested in the appropriate timing for initiation of continuous renal replacement therapy in critically ill surgical patients with postoperative acute  kidney injury. Seventy-three critically ill surgical patients with postoperative AKI who received continuous renal replacement therapy (CRRT) were enrolled. Indications for CRRT were: 1) AKI with hyperkalemia, 2) metabolic acidosis, 3) pulmonary edema refractory to diuretics, and 4) oliguria  with progressive azotemia, especially in unstable hemodynamics. Using RIFLE (Risk, Injury, Failure, Loss, End stage) classification, patients who received CRRT in the "Risk" stage were defined as early group, whereas those in the "Injury/ Failure" stage were labeled  as late group. We used continuous veno-venous hemofiltration as CRRT in this series. There were 20 patients in the early group and 53 patients in the late group. The mean ages were 61.5 ± 21.8 years versus 60.8 ± 17.5 years. The mortality rate was 50 per cent versus  84.9 per cent. There were no significant differences in demographic characteristics or type of surgery or physiological scores. Our data show that late initiation of CRRT is associated with a lower survival rate in critically ill surgical patients with postoperative AKI; however, further studies  are required.
authors.affiliation: Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan. rw114@mail.cmuh.org.tw
authors.forename: Shih-Chi
authors.initials: SC
authors.lastname: Wu
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Fu
authors.forename: Hsin-Hung
authors.initials: HH
authors.lastname: Lin
authors.forename: Ray-Jade
authors.initials: RJ
authors.lastname: Chen
authors.forename: Chi-Hsun
authors.initials: CH
authors.lastname: Hsieh
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Wang
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Yeh
authors.forename: Hung-Chang
authors.initials: HC
authors.lastname: Huang
authors.forename: Jui-Chien
authors.initials: JC
authors.lastname: Huang
authors.forename: Yu-Jun
authors.initials: YJ
authors.lastname: Chang
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors