title: IMPACT OF CONTINUOUS RENAL REPLACEMENT THERAPY INTENSITY ON SEPTIC ACUTE KIDNEY INJURY.
abstract: The intensity of continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) has been evaluated, but recent randomized clinical trials have failed to demonstrate a beneficial impact of high intensity on the outcomes. High intensity might cause some detrimental results recognized recently as CRRT trauma. This study was undertaken to evaluate the association of CRRT intensity with mortality in a population of AKI patients treated with lower-intensity CRRT in Japan. A retrospective single-center cohort study enrolled 125 AKI patients treated with CRRT in mixed intensive care units of a university hospital in Japan. Subanalysis was conducted for septic and postsurgical AKI. The median value of the prescribed total effluent rate was 20.1 (interquartile range 15.3-27.1) mL/kg/h. Overall, univariate Cox regression analysis indicated no association of the CRRT intensity with the 60-day in-hospital mortality rate (hazard ratio 1.006, 95% confidence interval [CI] 0.991-1.018, P = 0.343). In subanalysis with the septic AKI patients, multivariate analysis revealed two factors associated independently with the 60-day mortality rate: the Sequential Organ Failure Assessment score at initiation of CRRT (hazard ratio 1.152, 95% CI 1.025-1.301, P = 0.0171) and the CRRT intensity (hazard ratio 1.024, 95% CI 1.004-1.042, P = 0.0195). The CRRT intensity was associated significantly with higher 60-day in-hospital mortality in septic AKI, suggesting that unknown detrimental effects of CRRT with high-intensity CRRT might worsen the outcomes in septic AKI patients.
authors.affiliation: *Department of Nephrology and Endocrinology †22nd Century Medical and Research Center ‡Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Mayumi
authors.forename: Tetsushi
authors.initials: T
authors.lastname: Yamashita
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Hamasaki
authors.forename: Eisei
authors.initials: E
authors.lastname: Noiri
authors.forename: Masaomi
authors.initials: M
authors.lastname: Nangaku
authors.forename: Naoki
authors.initials: N
authors.lastname: Yahagi
authors.forename: Kent
authors.initials: K
authors.lastname: Doi
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D017582:Renal Replacement Therapy / Q000379:methods*; D012189:Retrospective Studies; D018805:Sepsis / Q000628:therapy*