Abstract: FR-PO054

Early Renal Replacement Therapy Improves Outcome of Burned Patients with AKI

Session Information

  • AKI Clinical: Predictors
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Liew, Zhong hong, Singapore General Hospital, Singapore, Singapore
  • Kaushik, Manish, Singapore General Hospital, Singapore, Singapore
  • Tan, Han K, Singapore General Hospital, Singapore, Singapore
  • Cheah, Andrew, Singhealth, Singapore, Singapore
  • Chong, Si jack, Singapore General Hospital, Singapore, Singapore
  • Tan, Bien keem, Singapore General Hospital, Singapore, Singapore
Background

Burned patients with acute kidney injury (AKI) require renal replacement therapy (RRT) have exceedingly high mortality rates of 73-100%. Since January 2011, we have been adopting early RRT approach in managing burned patients with AKI. Our hypothesis was that early initiation of RRT leads to improved outcome and survival among burned patients with AKI by allowing better management of fluid, electrolytes and acid-base balance

Methods

We conducted a retrospective analysis of Burns Database from January 2011 to February 2016. Indications for dialysis included serum creatinine > 1.5 times baseline or urine output < 0.5 ml/kg/h for at least 2 consecutive hours. Patients with similar parameters from January 2006 to December 2010 were recruited for comparison.

Results

A total of 27 patients with burns and AKI were recruited from January 2011 to February 2016. Mean age was 45.4 years and 88.9% were male. Mean TBSA was 54.8%. Total volume of fluid resuscitation was 2.7 ml/kg/TBSA. Time from onset of burn to RRT was 6.4 days. Majority of patients presented with stage 1 AKI (51.9%); while 22.2% and 25.9% had stage 2 and stage 3 AKI respectively. Most patients (74.1%) received CRRT and 18.5% received SLED. The mortality rate was 37.0% with majority (70%) were due to sepsis/multiorgan failure. Only 1 patient required long-term RRT after discharge and there was no occurrence of abdominal compartment syndrome. Mean age of 15 patients from 2006 to 2010 was 47.8 years. Mean TBSA was 49.5%. Only 26.7% of patients were started on RRT. The mortality rate was 66.7%, which was higher than that of subjects from 2011 to 2016 (37.0%).

Conclusion

We compared our findings with 5 studies published in recent 10 years on burned patients with AKI started on RRT and found that early RRT approach reduced mortality of burned patients with AKI. Optimal timing of RRT for burned patients with AKI has not been established and further large clinical trials are required .

 Steinvall 2008 (n=4)Chung 2009 (n= 29)Soltani 2009 (n= 33)Mariano 2010 (n=70)Gille (2014) (n=14)
Age (year)NA27 (mean)49 (mean)57.5 (median)64 (median)
TBSA (%)NA64% (mean)36% (mean)40% (median)42.5% (median)
Criteria to start RRTCreatinine > 300 μmol/L, together with oliguria or anuriaAKIN 2 + shock,
AKIN 3
Severe fluid overload refractory to diuretics
Refractory hyperkalemia
Severe metabolic acidosis Azotemia
NAOxygenation index (PaO2/FiO2) < 200 mmHg
Serum potassium > 6 mmol/L
Increase of serum creatinine > 200%
Reduction of glomerular filtration rate > 50%
Urea > 25 mmol/L
Diuresis ≤ 0.5 ml kg/hour for 6 hours
Rhabdomyolysis
Time to RRT (days from admission)Started on day 5 to 199 (median)14 (mean)16.8 (mean)6 (median)
Duration of RRT (days)Ranging from 10 to 15 days5.6 (mean)10.5 (mean)9.5 (mean)7 (median)
Abdominal compartment syndromeNANA7NANA
Mortality rate3 (75%)18 (62%)23 (69.7%)50 (71.4%)2 (11.1%)