title: Early continuous renal replacement therapy in septic acute kidney injury could be defined by its initiation within 24 hours of vasopressor infusion.
abstract: The optimal timing for the initiation of early continuous renal replacement therapy (CRRT) is uncertain and requires a practically feasible definition with acceptable evidence.
  
  
  
  We investigated the clinical impacts of 3-time interval parameters on the morbidity and mortality of 177 patients with septic shock-induced acute kidney injury: (1) time from vasopressor initiation to CRRT initiation (Tvaso-CRRT), (2) time from intensive care unit (ICU) admission to CRRT initation (TICU-CRRT), and (3) time from endotracheal intubation to CRRT initiation (Tendo-CRRT).
  
  
  
  The proportion of the patients with Tvaso-CRRTless than 24 h (median, 14 h, interquartile range [IQR], 5-30 h) was significantly higher in the survival group than in the non-survival group (84.3% vs. 58.5%, p < 0.001). Tvaso-CRRTless than 24 h and Sequential Organ Failure Assessment score were independent factors associated with 28-day mortality and 90-day mortality. TICU-CRRT(median, 17 h, IQR, 5-72 h) and Tendo-CRRT(median, 13 h, IQR, 4-48 h) were significantly correlated with both the length of ICU stay (p < 0.001) and mechanical ventilation duration (p < 0.001), but not mortality.
  
  
  
  Considering the possible therapeutic measurement by physician on the basis of the results in this study, early CRRT could be defined by a Tvaso-CRRTless than 24 h.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Electronic address: sdbaek@amc.seoul.kr.
authors.forename: Seung Don
authors.initials: SD
authors.lastname: Baek
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea. Electronic address: yuhoon721@gmail.com.
authors.forename: Hoon
authors.initials: H
authors.lastname: Yu
authors.affiliation: Department of Nursing, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Electronic address: seulseul03@daum.net.
authors.forename: Seulgi
authors.initials: S
authors.lastname: Shin
authors.affiliation: Department of Nursing, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Electronic address: blupuppy@hanmail.net.
authors.forename: Hyang-Sook
authors.initials: HS
authors.lastname: Park
authors.affiliation: Department of Nursing, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Electronic address: misoon@amc.seoul.kr.
authors.forename: Mi-Soon
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Dankook University College of Medicine, Cheonan-si, Chungnam, South Korea. Electronic address: zhidao79@naver.com.
authors.forename: So Mi
authors.initials: SM
authors.lastname: Kim
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Dankook University College of Medicine, Cheonan-si, Chungnam, South Korea. Electronic address: nephrologylek@hanmail.net.
authors.forename: Eun Kyoung
authors.initials: EK
authors.lastname: Lee
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Electronic address: jwchang@amc.seoul.kr.
authors.forename: Jai Won
authors.initials: JW
authors.lastname: Chang
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D000368:Aged; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D017582:Renal Replacement Therapy / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D012772:Shock, Septic / Q000150:complications / Q000401:mortality; D061665:Time-to-Treatment; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D014662:Vasoconstrictor Agents
keywords: Critical care; Mortality; Renal function; Renal replacement therapy