Early initiation of continuous renal replacement therapy improves patient survival in severe progressive septic acute kidney injury

Hyung Jung Oh, Dong Ho Shin, Mi Jung Lee, Hyang Mo Koo, Fa Mee Doh, Hyoung Rae Kim, Jae Hyun Han, Jung Tak Park, SeungHyeok Han, TaeHyun Yoo, Kyu Hun Choi, Shin-Wook Kang

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Purpose: The definition of "early" in terms of continuous renal replacement therapy (CRRT) initiation has not been uniformly used. Therefore, we tried to elucidate whether the timing of CRRT application, based on the interval between the start time of vasopressors infusion and CRRT initiation, was an independent predictor of mortality in the patients with septic acute kidney injury (AKI). Materials and Methods: Progressive septic AKI patients, in whom the infusion doses of vasopressors were increased compared with the initial dose during the first 6 hours of vasopressor treatment and CRRT was performed, between 2009 and 2011, were collected and divided into 2 groups based on the median interval between the 2 points. Results: A total of 210 patients were included. The mean age was 62.4 years, and 126 patients (60.0%) were male. The most common comorbid disease was malignancy (53.8%), followed by hypertension (35.7%) and diabetes mellitus (29.0%). The median interval between the start time of vasopressor infusion and CRRT commencement was 2.0 days. During the study period, 156 patients (74.3%) died within 28 days of CRRT application. The interval between 2 points was significantly shorter in the survivor compared with the death group (P < .001). Moreover, 28-day overall mortality rates in the early CRRT group were significantly lower than those in the late CRRT group (P = .034). Furthermore, early CRRT treatment was independently associated with a lower mortality rate even after adjustment for age, sex, causative organisms, and infection sites (P = .032). Conclusions: This retrospective cohort study suggests that early initiation of CRRT may be of benefit. Given the complex nature of this intervention, the ongoing controversies regarding early vs late initiation of therapy in acute and chronic situation, there is an urgent need to develop well-designed clinical trials to answer the question definitely.

Original languageEnglish
Pages (from-to)743.e9-743.e18
JournalJournal of Critical Care
Volume27
Issue number6
DOIs
Publication statusPublished - 2012 Jan 1

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Renal Replacement Therapy
Acute Kidney Injury
Survival
Mortality
Survivors
Diabetes Mellitus
Cohort Studies
Therapeutics
Retrospective Studies
Clinical Trials
Hypertension

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Oh, Hyung Jung ; Shin, Dong Ho ; Lee, Mi Jung ; Koo, Hyang Mo ; Doh, Fa Mee ; Kim, Hyoung Rae ; Han, Jae Hyun ; Park, Jung Tak ; Han, SeungHyeok ; Yoo, TaeHyun ; Choi, Kyu Hun ; Kang, Shin-Wook. / Early initiation of continuous renal replacement therapy improves patient survival in severe progressive septic acute kidney injury. In: Journal of Critical Care. 2012 ; Vol. 27, No. 6. pp. 743.e9-743.e18.
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title = "Early initiation of continuous renal replacement therapy improves patient survival in severe progressive septic acute kidney injury",
abstract = "Purpose: The definition of {"}early{"} in terms of continuous renal replacement therapy (CRRT) initiation has not been uniformly used. Therefore, we tried to elucidate whether the timing of CRRT application, based on the interval between the start time of vasopressors infusion and CRRT initiation, was an independent predictor of mortality in the patients with septic acute kidney injury (AKI). Materials and Methods: Progressive septic AKI patients, in whom the infusion doses of vasopressors were increased compared with the initial dose during the first 6 hours of vasopressor treatment and CRRT was performed, between 2009 and 2011, were collected and divided into 2 groups based on the median interval between the 2 points. Results: A total of 210 patients were included. The mean age was 62.4 years, and 126 patients (60.0{\%}) were male. The most common comorbid disease was malignancy (53.8{\%}), followed by hypertension (35.7{\%}) and diabetes mellitus (29.0{\%}). The median interval between the start time of vasopressor infusion and CRRT commencement was 2.0 days. During the study period, 156 patients (74.3{\%}) died within 28 days of CRRT application. The interval between 2 points was significantly shorter in the survivor compared with the death group (P < .001). Moreover, 28-day overall mortality rates in the early CRRT group were significantly lower than those in the late CRRT group (P = .034). Furthermore, early CRRT treatment was independently associated with a lower mortality rate even after adjustment for age, sex, causative organisms, and infection sites (P = .032). Conclusions: This retrospective cohort study suggests that early initiation of CRRT may be of benefit. Given the complex nature of this intervention, the ongoing controversies regarding early vs late initiation of therapy in acute and chronic situation, there is an urgent need to develop well-designed clinical trials to answer the question definitely.",
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Early initiation of continuous renal replacement therapy improves patient survival in severe progressive septic acute kidney injury. / Oh, Hyung Jung; Shin, Dong Ho; Lee, Mi Jung; Koo, Hyang Mo; Doh, Fa Mee; Kim, Hyoung Rae; Han, Jae Hyun; Park, Jung Tak; Han, SeungHyeok; Yoo, TaeHyun; Choi, Kyu Hun; Kang, Shin-Wook.

In: Journal of Critical Care, Vol. 27, No. 6, 01.01.2012, p. 743.e9-743.e18.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Early initiation of continuous renal replacement therapy improves patient survival in severe progressive septic acute kidney injury

AU - Oh, Hyung Jung

AU - Shin, Dong Ho

AU - Lee, Mi Jung

AU - Koo, Hyang Mo

AU - Doh, Fa Mee

AU - Kim, Hyoung Rae

AU - Han, Jae Hyun

AU - Park, Jung Tak

AU - Han, SeungHyeok

AU - Yoo, TaeHyun

AU - Choi, Kyu Hun

AU - Kang, Shin-Wook

PY - 2012/1/1

Y1 - 2012/1/1

N2 - Purpose: The definition of "early" in terms of continuous renal replacement therapy (CRRT) initiation has not been uniformly used. Therefore, we tried to elucidate whether the timing of CRRT application, based on the interval between the start time of vasopressors infusion and CRRT initiation, was an independent predictor of mortality in the patients with septic acute kidney injury (AKI). Materials and Methods: Progressive septic AKI patients, in whom the infusion doses of vasopressors were increased compared with the initial dose during the first 6 hours of vasopressor treatment and CRRT was performed, between 2009 and 2011, were collected and divided into 2 groups based on the median interval between the 2 points. Results: A total of 210 patients were included. The mean age was 62.4 years, and 126 patients (60.0%) were male. The most common comorbid disease was malignancy (53.8%), followed by hypertension (35.7%) and diabetes mellitus (29.0%). The median interval between the start time of vasopressor infusion and CRRT commencement was 2.0 days. During the study period, 156 patients (74.3%) died within 28 days of CRRT application. The interval between 2 points was significantly shorter in the survivor compared with the death group (P < .001). Moreover, 28-day overall mortality rates in the early CRRT group were significantly lower than those in the late CRRT group (P = .034). Furthermore, early CRRT treatment was independently associated with a lower mortality rate even after adjustment for age, sex, causative organisms, and infection sites (P = .032). Conclusions: This retrospective cohort study suggests that early initiation of CRRT may be of benefit. Given the complex nature of this intervention, the ongoing controversies regarding early vs late initiation of therapy in acute and chronic situation, there is an urgent need to develop well-designed clinical trials to answer the question definitely.

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