title: A comparison of preemptive versus standard renal replacement therapy for acute kidney injury after cardiac surgery.
abstract: The optimal timing of renal replacement therapy (RRT) initiation in patients undergoing cardiac surgery remains controversial. This study aimed to determine whether preemptive RRT or standard RRT was associated with hospital mortality in cardiac surgical patients with acute kidney injury (AKI).
  
  
  
  Data were retrospectively collected from patients who underwent cardiac surgery and experienced postoperative AKI requiring RRT at Zhongshan Hospital of Fudan University from September 1, 2006 to December 31, 2013. The patients were divided into two groups according to the RRT strategy applied.
  
  
  
  A total of 213 patients were enrolled in this study; 59 patients were categorized into the preemptive RRT group and 154 into the standard RRT group. The preemptive RRT group exhibited significantly lower mortality (33.90% versus 51.95%, P = 0.018) and time to recovery of renal function than the standard RRT group (15.34 ± 14.46 versus 22.88 ± 14.08 d, P = 0.022). Moreover, the preemptive RRT group showed significantly lower serum creatinine levels and higher proportions of recovery of renal function and weaning from RRT at death or discharge than the standard RRT group. There was no significant difference in the duration of mechanical ventilation, RRT, intensive care unit stay, or hospital stay between the two groups.
  
  
  
  In patients after cardiac surgery, preemptive RRT was associated with lower hospital mortality and faster and more frequent recovery of renal function than standard RRT. However, preemptive RRT did not affect other patient-centered outcomes including mechanical ventilation time, RRT time, or length of intensive care unit or hospital stay.
authors.affiliation: Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.
authors.forename: Xiao-Mei
authors.initials: XM
authors.lastname: Yang
authors.affiliation: Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.
authors.forename: Guo-Wei
authors.initials: GW
authors.lastname: Tu
authors.affiliation: Department of Nutrition, Zhongshan Hospital, Fudan University, Shanghai, P. R. China; Center of Clinical Epidemiology and Evidence-Based Medicine, Fudan University, Shanghai, P. R. China.
authors.forename: Jian
authors.initials: J
authors.lastname: Gao
authors.affiliation: Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.
authors.forename: Chun-Sheng
authors.initials: CS
authors.lastname: Wang
authors.affiliation: Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.
authors.forename: Du-Ming
authors.initials: DM
authors.lastname: Zhu
authors.affiliation: Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
authors.affiliation: Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, P. R. China. Electronic address: liu.lan@zs-hospital.sh.cn.
authors.forename: Lan
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, P. R. China. Electronic address: luo.zhe@zs-hospital.sh.cn.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Luo
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications; D057216:Propensity Score; D016016:Proportional Hazards Models; D017582:Renal Replacement Therapy / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute kidney injury; Cardiac surgery; Renal replacement therapy (RRT); Timing