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Multicenter Study
. 2009;13(5):R171.
doi: 10.1186/cc8147. Epub 2009 Oct 30.

Late initiation of renal replacement therapy is associated with worse outcomes in acute kidney injury after major abdominal surgery

Chih-Chung Shiao  1 , Vin-Cent Wu, Wen-Yi Li, Yu-Feng Lin, Fu-Chang Hu, Guang-Huar Young, Chin-Chi Kuo, Tze-Wah Kao, Down-Ming Huang, Yung-Ming Chen, Pi-Ru Tsai, Shuei-Liong Lin, Nai-Kuan Chou, Tzu-Hsin Lin, Yu-Chang Yeh, Chih-Hsien Wang, Anne Chou, Wen-Je Ko, Kwan-Dun Wu; National Taiwan University Surgical Intensive Care Unit-Associated Renal Failure Study Group
Collaborators, Affiliations
Multicenter Study

Late initiation of renal replacement therapy is associated with worse outcomes in acute kidney injury after major abdominal surgery

Chih-Chung Shiao et al. Crit Care. 2009.

Abstract

Introduction: Abdominal surgery is probably associated with more likelihood to cause acute kidney injury (AKI). The aim of this study was to evaluate whether early or late start of renal replacement therapy (RRT) defined by simplified RIFLE (sRIFLE) classification in AKI patients after major abdominal surgery will affect outcome.

Methods: A multicenter prospective observational study based on the NSARF (National Taiwan University Surgical ICU Associated Renal Failure) Study Group database. 98 patients (41 female, mean age 66.4 +/- 13.9 years) who underwent acute RRT according to local indications for post-major abdominal surgery AKI between 1 January, 2002 and 31 December, 2005 were enrolled The demographic data, comorbid diseases, types of surgery and RRT, as well as the indications for RRT were documented. The patients were divided into early dialysis (sRIFLE-0 or Risk) and late dialysis (LD, sRIFLE -Injury or Failure) groups. Then we measured and recorded patients' outcome including in-hospital mortality and RRT wean-off until 30 June, 2006.

Results: The in-hospital mortality was compared as endpoint. Fifty-seven patients (58.2%) died during hospitalization. LD (hazard ratio (HR) 1.846; P = 0.027), old age (HR 2.090; P = 0.010), cardiac failure (HR 4.620; P < 0.001), pre-RRT SOFA score (HR 1.152; P < 0.001) were independent indicators for in-hospital mortality.

Conclusions: The findings of this study support earlier initiation of acute RRT, and also underscore the importance of predicting prognoses of major abdominal surgical patients with AKI by using RIFLE classification.

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Figures

Figure 1
Figure 1
Approach to gathering and selecting patients. aA 44-year-old male received kidney transplantation prior to RRT. bA 85-year-old female whose hospital course is extremely long (727 days from RRT initiation to death, comparing to mean period of 34.3 ± 27.6 days in other 98 patients). ICU = intensive care unit; RRT = renal replacement therapy.
Figure 2
Figure 2
Cumulative patient survival between early and late dialysis groups defined by RIFLE classification. By Kaplan-Meier method. Brown solid line = early dialysis group (RIFLE-0 and -I, n = 51); black dashed line = late dialysis group (RIFLE-R and -F, n = 47). RRT = renal replacement therapy.
See this image and copyright information in PMC

Comment in

References

    1. de Mendonca A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, Takala J, Sprung C, Cantraine F. Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med. 2000;26:915–921. doi: 10.1007/s001340051281. - DOI - PubMed
    1. Kellum JA, Bellomo R, Ronco C. Definition and classification of acute kidney injury. Nephron Clin Pract. 2008;109:c182–187. doi: 10.1159/000142926. - DOI - PubMed
    1. Brienza N, Giglio MT, Marucci M, Fiore T. Does perioperative hemodynamic optimization protect renal function in surgical patients? A meta-analytic study. Crit Care Med. 2009;37:2079–2090. doi: 10.1097/CCM.0b013e3181a00a43. - DOI - PubMed
    1. Kheterpal S, Tremper KK, Englesbe MJ, O'Reilly M, Shanks AM, Fetterman DM, Rosenberg AL, Swartz RD. Predictors of postoperative acute renal failure after noncardiac surgery in patients with previously normal renal function. Anesthesiology. 2007;107:892–902. doi: 10.1097/01.anes.0000290588.29668.38. - DOI - PubMed
    1. Sear JW. Kidney dysfunction in the postoperative period. Br J Anaesth. 2005;95:20–32. doi: 10.1093/bja/aei018. - DOI - PubMed

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