Abstract: SA-PO658

Impact of Early Initiation of Continuous Renal Replacement Therapy in Critically Ill Patients with AKI

Session Information

Category: Dialysis

  • 602 Dialysis for AKI: Hemodialysis, CRRT, SLED, Others

Authors

  • Yang, Jihyun, Korea University Medical Center, Sungbuk-Gu, Seoul, Korea (the Republic of)
  • Hwang, Taeyeon, Korea University Medical Center, Sungbuk-Gu, Seoul, Korea (the Republic of)
  • Lim, Sung Yoon, Korea University Medical Center, Sungbuk-Gu, Seoul, Korea (the Republic of)
  • Cho, Woori Crystal, Korea University Medical Center, Sungbuk-Gu, Seoul, Korea (the Republic of)
  • Choi, Yoon kyung, Korea University Medical Center, Sungbuk-Gu, Seoul, Korea (the Republic of)
  • Kim, Myung-gyu, National Institutes of Health, North Bethesda, Maryland, United States
  • Jo, Sang-Kyung, Korea University Medical Center, Sungbuk-Gu, Seoul, Korea (the Republic of)
  • Cho, Won-Yong, Korea University Medical Center, Sungbuk-Gu, Seoul, Korea (the Republic of)
Background

The overall incidence of acute kidney injury (AKI) in ICU patients range from 20% to 50% and AKI represents a significant risk factor for mortality ICU patients with AKI ≥ 50%. CRRT (Continuous renal replacement therapy) widely used in ICU because of slower solute clearance and removal of fluid (better hemodynamic tolerance). However the optimal timing for initiation of CRRT in critically ill patients with AKI remains controversial. The purpose of this study is to investigate the outcomes of patients who received CRRT without any of these indications (Non-classic) with patients with one or more of these indications (Classic).

Methods

This is a retrospective single center cohort study enrolling patients who underwent CRRT in Korea University Anam Hospital. CRRT is run by the specialized CRRT team composed of two specialized nephrologists, an Intensivist, and two CRRT specialized nurses. The primary clinical outcome variables were 90-day Mortality and Renal recovery. Renal recovery was defined by creatinine clearance (≥15 mL/minute) with no need of renal replacement therapy at 90 days.

Results

At 90 days after CRRT, the mortality rate in the Classic group was 79.4% and that in the Non-classic group was 57.1%. Delayed initiation of CRRT was independently associated with greater odds of 90 day mortality. The classic group had lower renal recovery than the non-classic group. Delayed initiation of CRRT was independently associated with greater odds of non renal recovery.

Conclusion

In conclusion, initiating CRRT in critically ill patients with AKI should not be delayed until fulfillment of classic indications.