title: Impact of dialysis practice patterns on outcomes in acute kidney injury in Intensive Care Unit.
abstract: OBJECTIVE
  Recent advances in dialysis therapy have made an impact on the clinical practice of renal replacement therapy (RRT) in acute kidney injury (AKI) in Intensive Care Unit (ICU). We studied the impact of RRT practice changes on outcomes in AKI in ICU over a period of 8 years.
  
  
  METHODS
  AKI patients requiring RRT in ICU referred to a nephrologist during two different periods (period-1: Between May 2004 and May 2007, n = 69; period-2: Between August 2008 and May 2011, n = 93) were studied. The major changes in the dialysis practice during the period-2, compared to period-1 were introduction of prolonged intermittent RRT (PIRRT), early dialysis for metabolic acidosis, early initiation of RRT for anuria and positive fluid balance and use of bicarbonate-based fluids for continuous RRT (CRRT) instead of lactate buffer. The primary study outcome was 28-day hospital mortality.
  
  
  RESULTS
  The mean age was 53.8 ± 16.1 years and 72.6% were male. Introduction of PIRRT resulted in 37% reduction in utilization of CRRT during period-2 (from 85.5% to 53.7%). The overall mortality was high (68%) but was significantly reduced during period-2 compared to period-1 (59% vs. 79.7%, P = 0.006). Metabolic acidosis but not the mode of RRT, was the significant factor which influenced mortality.
  
  
  CONCLUSIONS
  Adaption of PIRRT resulted in 37% reduction of utilization of CRRT. The mortality rate was significantly reduced during the period of adaption of PIRRT, possibly due to early initiation of RRT in the latter period for indications such as anuria and metabolic acidosis.
authors.affiliation: Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India.
authors.forename: Rajeev A
authors.initials: RA
authors.lastname: Annigeri
authors.affiliation: Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India.
authors.forename: Venkatappa
authors.initials: V
authors.lastname: Nandeesh
authors.affiliation: Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India.
authors.forename: Ramanathan
authors.initials: R
authors.lastname: Karuniya
authors.affiliation: Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India.
authors.forename: Sasikumar
authors.initials: S
authors.lastname: Rajalakshmi
authors.affiliation: Department of Nephrology, Critical Care Unit, Apollo Hospitals, Chennai, Tamil Nadu, India.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Venkataraman
authors.affiliation: Department of Nephrology, Critical Care Unit, Apollo Hospitals, Chennai, Tamil Nadu, India.
authors.forename: Nagarajan
authors.initials: N
authors.lastname: Ramakrishnan
keywords: Acute kidney injury; continuous renal replacement therapy hemodialysis; prolonged intermittent renal replacement therapy