title: Acute kidney injury in critical care: experience of a conservative strategy.
abstract: OBJECTIVE
  Renal replacement therapy (RRT) is a major supportive treatment of acute kidney injury (AKI) in intensive care unit (ICU), but the timing of its initiation remains open to debate.
  
  
  METHODS
  We retrospectively analyzed ICU patients who had AKI associated with at least one usual RRT criteria: serum creatinine concentration greater than 300 μmol/L, serum urea concentration greater than 25 mmol/L, serum potassium concentration greater than 6.5 mmol/L, severe metabolic acidosis (arterial blood pH<7.2), oliguria (urine output<135 mL/8 hours or <400 mL/24 hours), overload pulmonary edema. To estimate the risk of death associated with RRT adjusted for risk factors, we performed a marginal structural Cox model with inverse-probability-of-treatment-weighted estimator.
  
  
  RESULTS
  Among 4173 patients admitted to the ICU, 203 patients fulfilled potential RRT criteria. Ninety-one patients (44.8%) received RRT and 112 (55.2%) did not. Non-RRT and RRT patients differed in terms of severity of illness: Simplified Acute Physiology Score II (55±17 vs 60±19, respectively; P<.05) and Sequential Organ Failure Assessment score (8 [5-10] vs 9 [7-11], respectively; P=.01). Crude analysis indicated a lower ICU mortality for non-RRT compared with RRT patients (18% vs 45%; P<.001). In the marginal structural Cox model, RRT was associated with increased mortality (P<.01).
  
  
  CONCLUSIONS
  A conservative approach of AKI was not associated with increased mortality.
authors.affiliation: AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France; Univ Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, F-75010 Paris, France; INSERM, ECEVE, U1123, F-75010 Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Gaudry
authors.affiliation: AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France; Univ Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, F-75018 Paris, France; INSERM, IAME, U1137, F-75018 Paris, France.
authors.forename: Jean-Damien
authors.initials: JD
authors.lastname: Ricard
authors.affiliation: AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Leclaire
authors.affiliation: AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Rafat
authors.affiliation: AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France; Univ Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, F-75018 Paris, France; INSERM, IAME, U1137, F-75018 Paris, France.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Messika
authors.affiliation: AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Bedet
authors.affiliation: AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France.
authors.forename: Lucile
authors.initials: L
authors.lastname: Regard
authors.affiliation: AP-HP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, 178 rue des Renouillers, F-92700, Colombes, France; Univ Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, F-75010 Paris, France; INSERM, ECEVE, U1123, F-75010 Paris, France; INSERM, CIE-1425, F-75018, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Hajage
authors.affiliation: AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France; Univ Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, F-75018 Paris, France; INSERM, IAME, U1137, F-75018 Paris, France. Electronic address: didier.dreyfuss@lmr.aphp.fr.
authors.forename: Didier
authors.initials: D
authors.lastname: Dreyfuss
mesh_terms: D018806:APACHE; D000138:Acidosis; D058186:Acute Kidney Injury / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D000368:Aged; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D003422:Critical Care; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009846:Oliguria / Q000503:physiopathology; D063305:Organ Dysfunction Scores; D011188:Potassium / Q000097:blood; D017582:Renal Replacement Therapy / Q000401:mortality* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D003404:Creatinine; D011188:Potassium
keywords: Acute kidney injury; Critical care; Renal replacement therapy; Treatment outcome