Survival in critically ill patients with acute kidney injury treated with early hemodiafiltration.
OBJECTIVE
Early renal replacement therapy (RRT) initiation should theoretically influence many physiological disorders related to acute kidney injury (AKI). Currently, there is no consensus about RRT timing in intensive care unit (ICU) patients.


METHODS
We performed a retrospective analysis of all critically ill patients who received RRT in our ICU during a 3 year-period. Our goal was to identify mortality risk factors and if RRT initiation timing had an impact on survival. RRT timing was calculated from the moment the patient was classified as having acute kidney injury in the RIFLE classification.


RESULTS
A hundred and ten patients received RRT. We identified four independent mortality risk factors: need for mechanical ventilation (OR = 12.82 (1.305 - 125.868, p = 0.0286); RRT initiation timing >16 h (OR = 5.66 (1.954 - 16.351), p = 0.0014); urine output on admission <500 ml/day (OR = 4.52 (1.666 - 12.251), p = 0.003); and SAPS II on admission >70 (OR = 3.45 (1.216 - 9.815), p = 0.02). The RRT initiation =16 h and RRT initiation >16 h groups presented the same baseline characteristics, except for more severe gravity scores and kidney failure in the early RRT group.


CONCLUSIONS
Early RRT in ICU patients with acute kidney injury or failure was associated with increased survival.
Intensive Care and Infectious Disease Unit, Tourcoing Hospital, University of Lille, Tourcoing, France. nboussekey@ch-tourcoing.fr
Nicolas
N
Boussekey
Benoit
B
Capron
Pierre-Yves
PY
Delannoy
Patrick
P
Devos
Serge
S
Alfandari
Arnaud
A
Chiche
Agnes
A
Meybeck
Hugues
H
Georges
Olivier
O
Leroy
D058186:Acute Kidney Injury / Q000401:mortality* / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D017583:Hemodiafiltration; D006801:Humans; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome