title: Who may not benefit from continuous renal replacement therapy in acute kidney injury?
abstract: This study aimed to identify factors that may predict early kidney recovery (less than 48 hours) or early death (within 48 hours) after initiating continuous renal replacement therapy (CRRT) in acute kidney injury (AKI) patients. This is a multicenter retrospective observational study of 14 Japanese Intensive care units (ICUs) in 12 tertiary hospitals. Consecutive adult patients with severe AKI requiring CRRT admitted to the participating ICUs in 2010 (n=343) were included. Patient characteristics, variables at CRRT initiation, settings, and outcomes were collected. Patients were grouped into early kidney recovery group (CRRT discontinuation within 48 hours after initiation, n=52), early death group (death within 48 hours after CRRT initiation, n=52), and the rest as the control group (n=239). The mean duration of CRRT in the early kidney recovery group and early death group was 1.3 and 0.9 days, respectively. In multivariable regression analysis, in comparison with the control group, urine output (mL/h) (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01-1.03), duration between ICU admission to CRRT initiation (days) (OR: 0.65, 95% CI: 0.43-0.87), and the sepsis-related organ failure assessment score (OR: 0.87, 95% CI; 0.78-0.96) were related to early kidney recovery. Serum lactate (mmol/L) (OR: 1.19, 95% CI: 1.11-1.28), albumin (g/dL) (OR: 0.52, 95% CI: 0.28-0.92), vasopressor use (OR: 3.68, 95% CI: 1.37-12.16), and neurological disease (OR: 9.64, 96% CI: 1.22-92.95) were related to early death. Identifying AKI patients who do not benefit from CRRT and differentiating such patients from the study cohort may allow previous and future studies to effectively evaluate the indication and role of CRRT.
authors: Department of Nephrology and Hypertension, St. Marianna University School of Medicine, Kanagawa, Japan.
authors: Hiroo
authors: H
authors: Kawarazaki
authors: Shigehiko
authors: S
authors: Uchino
authors: Natsuko
authors: N
authors: Tokuhira
authors: Tetsu
authors: T
authors: Ohnuma
authors: Yoshitomo
authors: Y
authors: Namba
authors: Shinshu
authors: S
authors: Katayama
authors: Noriyoshi
authors: N
authors: Toki
authors: Kenta
authors: K
authors: Takeda
authors: Hideto
authors: H
authors: Yasuda
authors: Junichi
authors: J
authors: Izawa
authors: Makiko
authors: M
authors: Uji
authors: Isao
authors: I
authors: Nagata
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy / Q000628:therapy*; D000368:Aged; D003625:Data Collection; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D017582:Renal Replacement Therapy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Acute kidney injury; continuous renal replacement therapy; critically ill; early death; early kidney recovery