title: [Role of acute kidney injury staging by KDIGO criteria in choosing the opportune time of continuous blood purification].
abstract: OBJECTIVE
  To investigate the role of acute kidney injury staging in multiple organ dysfunction syndrome (MODS) patients with acute kidney injury (AKI) for deciding the opportune time of continuous blood purification (CBP).
  
  
  METHODS
  A retrospective study was conducted. One hundred and twenty-six MODS patients with AKI in general intensive care unit (ICU) and emergency intensive care unit (EICU) requiring continuous venous-venous hemofiltration treatment were enrolled. According to the criteria of "Kidney Disease: Improving Global Outcomes Organization (KDIGO standard)" and acute physiology and chronic health evaluation II (APACHEII) score, the patients were stratified into KDIGO 1, 2, 3 groups and APACHEII score of <15, 15-25, >25 groups. ICU survival rate and renal function outcome, CBP treatment total ultrafiltration, average ICU day and the average medical costs of survivals were compared among groups.
  
  
  RESULTS
  Compared with APACHEII ≤ 25, KDIGO 1, 2 hospitalized patients had significantly higher survival rate [94.1% (32/34) vs. 76.8% (43/56), P<0.05]. Renal function improvement rate in survivors of KDIGO 1, 2 patients was significantly higher than that in APACHEII ≤ 25 [90.6% (29/32) vs. 62.8 (27/43), P<0.01], and number of patients requiring CBP treatment, mean ICU day, and medical expenses were significantly reduced (CBP treatment of total ultrafiltration: 199.0±44.7 L vs. 239.0 ± 73.3 L, the mean length of stay in ICU: 12.9±3.4 days vs. 15.1±4.8 days, medical expenses: 2.6±0.4 million vs. 3.0±1.0 million, all P<0.05). There was no significant difference in above indexes between survivors in KDIGO 3 and APACHEII>25, and the indexes in KDIGO 3 and APACHEII >25 were worse than those in KDIGD 1, 2 and APACHEII>25.
  
  
  CONCLUSIONS
  In patients of MODS accompanied by AKI, compared using as APACHEIIscore≤25 as opportune time to start CBP, to commence the treatment in the period of KDIGO standard 1, 2 cannot only improve patient survival with recovery of renal function, but also can reduce the ICU stay and medical expenses.
authors.affiliation: Department of Critical Care Medicine, Chengde City Central Hospital, Chengde 067000, Hebei, China. 2008zhoujx@163.com
authors.forename: Jing-xia
authors.initials: JX
authors.lastname: Zhou
authors.forename: Pei-cong
authors.initials: PC
authors.lastname: You
authors.forename: Chun-tao
authors.initials: CT
authors.lastname: Liu
authors.forename: Da-peng
authors.initials: DP
authors.lastname: Zhou
authors.forename: Peng-fei
authors.initials: PF
authors.lastname: Zhang
authors.forename: Jie
authors.initials: J
authors.lastname: Zhang
authors.forename: Rui-nian
authors.initials: RN
authors.lastname: Cheng
mesh_terms: D018806:APACHE; D058186:Acute Kidney Injury / Q000150:complications / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult