Timing of Renal Replacement Therapy and its impact on the Outcome of Acute Kidney Injury Patients | ||||
| The Egyptian Journal of Hospital Medicine | ||||
| Article 30, Volume 72, Issue 7, July 2018, Page 4956-4963 PDF (369.75 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejhm.2018.10180 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
Ahmed Mohammed Owais Elhawy  ; Mohammed Zaher Sadaka; Fawzy Hamed Hasan; Haytham Sabry Abdul Hamed; Mohamed Ahmed Elsayed
| ||||
| Department of Internal Medicine and Nephrology, Faculty of Medicine, Al-Azhar University | ||||
| Abstract | ||||
| Background: Previous studies using Acute Kidney Injury Network (AKIN)/RIFLE criteria to classify early initiation of renal replacement therapy (RRT) have defined it as the therapy started in less severe AKIN/RIFLE stages. Generally, these studies failed in demonstrating measurable benefits. Aim: To evaluate RRT in critically ill patients and its timing and its impact on critically ill patients. Methods: We compared RRT initiation in critically ill patients and defined early or late RRT in reference to timing after stage 3 AKIN was met: patients beginning RRT within 24 hours after acute kidney injury (AKI) stage 3 were considered early starters. AKIN criteria were evaluated by both urine output (UO) and serum creatinine (sCr) and patients with acute-on-chronic kidney disease were excluded. A propensity score methodology was used to control variables. Results: A total of 358 critically ill patients were submitted to RRT. Only 150 patients with pure AKI at stage 3 were analyzed. Mortality was lower in the early RRT group (51.5 vs. 77.9%, P = 0.001). After achieving balance between the groups using a propensity score, there was a significant 30.5 (95% confidence interval [CI] 14.4 to 45.2%, P = 0.002) relative decrease of mortality in the early RRT group. Moreover, patients on the early RRT group had lower duration of mechanical ventilation, time on RRT and a trend to lower intensive care unit (ICU) length of stay. Conclusions: For the first time, AKIN was used with UO criterion to evaluate early and late RRT. Using a time based approach could be a better parameter to access the association between RRT initiation and outcomes in patients with AKI. | ||||
| Keywords | ||||
| RRT; AKI; AKIN; RIFLE; Critically Ill Patients | ||||
|
Statistics Article View: 178 PDF Download: 317 |
||||
