Can early initiation of continuous renal replacement therapy improve patient survival with septic acute kidney injury when enrolled in early goal-directed therapy?

Hyung Jung Oh, Min Hyung Kim, Jin Young Ahn, Nam Su Ku, Jung Tak Park, Sang Hoon Han, JunYong Choi, SeungHyeok Han, TaeHyun Yoo, Young Goo Song, Shin-Wook Kang, June Myung Kim

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Purpose The purpose of our study was to investigate the timing of continuous renal replacement therapy (CRRT) application, based on the interval between the start of early goal-directed therapy (EGDT) and CRRT initiation, to ascertain whether the timing was an independent predictor of mortality in patients with septic acute kidney injury (AKI). Materials and methods An observational retrospective cohort study was conducted of 60 patients (> 18 years old) who had been admitted to the emergency department and received resuscitation according to the standard EGDT algorithm for severe sepsis and septic shock, and who were treated with CRRT due to septic AKI, between June 2008 and February 2013 at a tertiary hospital in Seoul, Korea. The patients were divided into 2 groups based on the median interval between the start of EGDT and the commencement of CRRT. The main outcome was 28-day all-cause mortality, and a multivariate Cox analysis for mortality was used to evaluate the independent impact of the early CRRT treatment. Results The mean patient age was 66.3 years, and 52 (86.7%) were male. The most common comorbid disease was diabetes mellitus (35.0%) followed by malignancy (26.7%). The median interval between the start of EGDT and commencement of CRRT was 26.4 hours. During the study period, 28-day mortality was 43.3% (26 of 60 patients). The 28-day all-cause mortality rate was significantly higher in the late CRRT group than in the early CRRT group (56.7 vs 30.0%, P= .037). Furthermore, the higher mortality risk in the late group remained significant even after adjusting for diabetes mellitus, liver failure, and Acute Physiology and Chronic Health Evaluation II scores (hazard ratio, 2.461; 95% confidence interval, 1.044-5.800; P= .026). Conclusion Early initiation of CRRT may be of benefit. Given the complex nature of this intervention and the ongoing controversy regarding early vs late initiation of therapy in acute and chronic situations, it is vital to develop accurate clinical trials to find definitive answers.

Original languageEnglish
Pages (from-to)51-56
Number of pages6
JournalJournal of Critical Care
Volume35
DOIs
Publication statusPublished - 2016 Oct 1

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Renal Replacement Therapy
Acute Kidney Injury
Survival
Mortality
Therapeutics
Diabetes Mellitus
APACHE
Liver Failure
Korea
Septic Shock
Tertiary Care Centers
Resuscitation
Hospital Emergency Service
Sepsis
Cohort Studies
Multivariate Analysis
Retrospective Studies
Clinical Trials
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

@article{f0eabef8627e43d5a309a9852379cd2c,
title = "Can early initiation of continuous renal replacement therapy improve patient survival with septic acute kidney injury when enrolled in early goal-directed therapy?",
abstract = "Purpose The purpose of our study was to investigate the timing of continuous renal replacement therapy (CRRT) application, based on the interval between the start of early goal-directed therapy (EGDT) and CRRT initiation, to ascertain whether the timing was an independent predictor of mortality in patients with septic acute kidney injury (AKI). Materials and methods An observational retrospective cohort study was conducted of 60 patients (> 18 years old) who had been admitted to the emergency department and received resuscitation according to the standard EGDT algorithm for severe sepsis and septic shock, and who were treated with CRRT due to septic AKI, between June 2008 and February 2013 at a tertiary hospital in Seoul, Korea. The patients were divided into 2 groups based on the median interval between the start of EGDT and the commencement of CRRT. The main outcome was 28-day all-cause mortality, and a multivariate Cox analysis for mortality was used to evaluate the independent impact of the early CRRT treatment. Results The mean patient age was 66.3 years, and 52 (86.7{\%}) were male. The most common comorbid disease was diabetes mellitus (35.0{\%}) followed by malignancy (26.7{\%}). The median interval between the start of EGDT and commencement of CRRT was 26.4 hours. During the study period, 28-day mortality was 43.3{\%} (26 of 60 patients). The 28-day all-cause mortality rate was significantly higher in the late CRRT group than in the early CRRT group (56.7 vs 30.0{\%}, P= .037). Furthermore, the higher mortality risk in the late group remained significant even after adjusting for diabetes mellitus, liver failure, and Acute Physiology and Chronic Health Evaluation II scores (hazard ratio, 2.461; 95{\%} confidence interval, 1.044-5.800; P= .026). Conclusion Early initiation of CRRT may be of benefit. Given the complex nature of this intervention and the ongoing controversy regarding early vs late initiation of therapy in acute and chronic situations, it is vital to develop accurate clinical trials to find definitive answers.",
author = "Oh, {Hyung Jung} and Kim, {Min Hyung} and Ahn, {Jin Young} and Ku, {Nam Su} and Park, {Jung Tak} and Han, {Sang Hoon} and JunYong Choi and SeungHyeok Han and TaeHyun Yoo and Song, {Young Goo} and Shin-Wook Kang and Kim, {June Myung}",
year = "2016",
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language = "English",
volume = "35",
pages = "51--56",
journal = "Journal of Critical Care",
issn = "0883-9441",
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Can early initiation of continuous renal replacement therapy improve patient survival with septic acute kidney injury when enrolled in early goal-directed therapy? / Oh, Hyung Jung; Kim, Min Hyung; Ahn, Jin Young; Ku, Nam Su; Park, Jung Tak; Han, Sang Hoon; Choi, JunYong; Han, SeungHyeok; Yoo, TaeHyun; Song, Young Goo; Kang, Shin-Wook; Kim, June Myung.

In: Journal of Critical Care, Vol. 35, 01.10.2016, p. 51-56.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Can early initiation of continuous renal replacement therapy improve patient survival with septic acute kidney injury when enrolled in early goal-directed therapy?

AU - Oh, Hyung Jung

AU - Kim, Min Hyung

AU - Ahn, Jin Young

AU - Ku, Nam Su

AU - Park, Jung Tak

AU - Han, Sang Hoon

AU - Choi, JunYong

AU - Han, SeungHyeok

AU - Yoo, TaeHyun

AU - Song, Young Goo

AU - Kang, Shin-Wook

AU - Kim, June Myung

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Purpose The purpose of our study was to investigate the timing of continuous renal replacement therapy (CRRT) application, based on the interval between the start of early goal-directed therapy (EGDT) and CRRT initiation, to ascertain whether the timing was an independent predictor of mortality in patients with septic acute kidney injury (AKI). Materials and methods An observational retrospective cohort study was conducted of 60 patients (> 18 years old) who had been admitted to the emergency department and received resuscitation according to the standard EGDT algorithm for severe sepsis and septic shock, and who were treated with CRRT due to septic AKI, between June 2008 and February 2013 at a tertiary hospital in Seoul, Korea. The patients were divided into 2 groups based on the median interval between the start of EGDT and the commencement of CRRT. The main outcome was 28-day all-cause mortality, and a multivariate Cox analysis for mortality was used to evaluate the independent impact of the early CRRT treatment. Results The mean patient age was 66.3 years, and 52 (86.7%) were male. The most common comorbid disease was diabetes mellitus (35.0%) followed by malignancy (26.7%). The median interval between the start of EGDT and commencement of CRRT was 26.4 hours. During the study period, 28-day mortality was 43.3% (26 of 60 patients). The 28-day all-cause mortality rate was significantly higher in the late CRRT group than in the early CRRT group (56.7 vs 30.0%, P= .037). Furthermore, the higher mortality risk in the late group remained significant even after adjusting for diabetes mellitus, liver failure, and Acute Physiology and Chronic Health Evaluation II scores (hazard ratio, 2.461; 95% confidence interval, 1.044-5.800; P= .026). Conclusion Early initiation of CRRT may be of benefit. Given the complex nature of this intervention and the ongoing controversy regarding early vs late initiation of therapy in acute and chronic situations, it is vital to develop accurate clinical trials to find definitive answers.

AB - Purpose The purpose of our study was to investigate the timing of continuous renal replacement therapy (CRRT) application, based on the interval between the start of early goal-directed therapy (EGDT) and CRRT initiation, to ascertain whether the timing was an independent predictor of mortality in patients with septic acute kidney injury (AKI). Materials and methods An observational retrospective cohort study was conducted of 60 patients (> 18 years old) who had been admitted to the emergency department and received resuscitation according to the standard EGDT algorithm for severe sepsis and septic shock, and who were treated with CRRT due to septic AKI, between June 2008 and February 2013 at a tertiary hospital in Seoul, Korea. The patients were divided into 2 groups based on the median interval between the start of EGDT and the commencement of CRRT. The main outcome was 28-day all-cause mortality, and a multivariate Cox analysis for mortality was used to evaluate the independent impact of the early CRRT treatment. Results The mean patient age was 66.3 years, and 52 (86.7%) were male. The most common comorbid disease was diabetes mellitus (35.0%) followed by malignancy (26.7%). The median interval between the start of EGDT and commencement of CRRT was 26.4 hours. During the study period, 28-day mortality was 43.3% (26 of 60 patients). The 28-day all-cause mortality rate was significantly higher in the late CRRT group than in the early CRRT group (56.7 vs 30.0%, P= .037). Furthermore, the higher mortality risk in the late group remained significant even after adjusting for diabetes mellitus, liver failure, and Acute Physiology and Chronic Health Evaluation II scores (hazard ratio, 2.461; 95% confidence interval, 1.044-5.800; P= .026). Conclusion Early initiation of CRRT may be of benefit. Given the complex nature of this intervention and the ongoing controversy regarding early vs late initiation of therapy in acute and chronic situations, it is vital to develop accurate clinical trials to find definitive answers.

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