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Kidney Week

Abstract: SA-PO555

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

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Lee, Junyong, Korea University Anam Hospital, Seongbuk-Gu, SEOUL, Korea (the Republic of)
  • Yang, Jihyun, Korea University Anam Hospital, Seongbuk-Gu, SEOUL, Korea (the Republic of)
  • Jo, Sang-Kyung, Korea University Anam Hospital, Seongbuk-Gu, SEOUL, Korea (the Republic of)
  • Oh, Sewon, Korea University Anam Hospital, Seongbuk-Gu, SEOUL, Korea (the Republic of)
  • Kim, Myung-Gyu, Korea University Anam Hospital, Seongbuk-Gu, SEOUL, Korea (the Republic of)
Background

The acute kidney injury (AKI) in ICU patients is one of a risk factor for mortality ICU patients. Continuous renal replacement therapy (CRRT) widely used in various situation, but the optimal timing for initiation of CRRT in critically ill patients with AKI remains controversial. The purpose of this study is to investigate the impact of early, preemptive initiation on outcomes of AKI patients in ICU compare to classic, delayed initiation.

Methods

This is two center retrospective review from 2014 to 2017. Any type of stage IV cancer patients, CRRT duration less than 24 hours, end-stage renal disease with hemodialysis or peritoneal dialysis or kidney transplanted patients were excluded. 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 for renal replacement therapy at 90 days.

Results

Total 1152 patients are included, 583 patients were analyzed. Compare to delayed initiation group, early initiation group had lower eGFR(80 vs 52 mL/min/1.73m2 , p<0.001), more chronic kidney disease patients which is defined eGFR lower than 60 mL/min/1.73m2 (59 vs 19%, p<0.001), more extra-corporeal membrane oxygenation application (1 vs 8%, p=0.005), longer survival period (42.2 vs 58.01 days, p=0.03), severe inflammatory/infectious condition (leukocytosis and higher C-reactive protein level). Ventilator care and higher APACHE-II score, classic initiation of CRRT were risk factors for non-real recovery at 90day. Elderly, CKD, underlying liver disease, higher APACHE-II score, ECMO, and delayed initiation were risk factors for 90-day mortality.

Conclusion

Delayed initiation of CRRT was independently associated with 90-day mortality. They showed lower renal recovery than the non-classic group. Delayed initiation of CRRT was independently associated with greater odds of non-renal recovery. Initiating CRRT in critically ill patients with AKI should not be delayed until fulfillment of classic indications.