Early initiation of continuous renal replacement therapy improves survival of elderly patients with acute kidney injury: A multicenter prospective cohort study

Jae Yoon Park, Jung Nam An, Jong Hyun Jhee, Dong Ki Kim, Hyung Jung Oh, Sejoong Kim, Kwon Wook Joo, Yun Kyu Oh, Chun Soo Lim, Shin Wook Kang, Yon Su Kim, Jung Tak Park, Jung Pyo Lee

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Abstract

Background: Continuous renal replacement therapy (CRRT) is essential in the management of critically ill patients with acute kidney injury (AKI). However, the optimal timing for initiating CRRT remains controversial, especially in elderly patients. Therefore, we investigated the outcomes of early CRRT initiation in elderly patients with AKI. Methods: A total of 607 patients ≥65 years of age who started CRRT due to AKI between August 2009 and December 2013 were prospectively enrolled. They were divided into two groups based on the median 6-hour urine output immediately before CRRT initiation. Propensity score matching was used to compare the overall survival rate, CRRT duration, and hospitalization duration. Results: The median age of both groups was 73.0 years, and 60 % of the patients were male. The most common cause of AKI was sepsis. In the early CRRT group, the mean arterial pressure was higher, but the prothrombin time and total bilirubin, aspartate aminotransferase, and alanine aminotransferase levels were lower. The overall cumulative survival rate was higher in the early CRRT group (log-rank P < 0.01). Late CRRT initiation was associated with a higher mortality rate than early initiation after adjusting for age, sex, the Charlson comorbidity index, systolic arterial pressure, prothrombin time, the total bilirubin, aspartate aminotransferase, and alanine aminotransferase levels, cumulative fluid balance and diuretic use (hazard ratio, 1.35; 95 % confidence interval 1.06, 1.71, P = 0.02). Following propensity score matching, patient survival was significantly better in the early CRRT group than in the late CRRT group (P < 0.01). The total duration of hospitalization from the start of CRRT was shorter among the survivors when CRRT was started earlier (26.7 versus 39.1 days, P = 0.04). Conclusion: A better prognosis can be expected if CRRT is applied early in the course of AKI in critically ill, elderly patients.

Original languageEnglish
Article number260
JournalCritical Care
Volume20
Issue number1
DOIs
Publication statusPublished - 2016 Aug 16

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Renal Replacement Therapy
Acute Kidney Injury
Cohort Studies
Prospective Studies
Survival
Propensity Score
Prothrombin Time
Aspartate Aminotransferases
Alanine Transaminase
Bilirubin
Critical Illness
Arterial Pressure
Hospitalization
Survival Rate
Water-Electrolyte Balance
Diuretics
Survivors
Comorbidity
Sepsis

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Park, Jae Yoon ; An, Jung Nam ; Jhee, Jong Hyun ; Kim, Dong Ki ; Oh, Hyung Jung ; Kim, Sejoong ; Joo, Kwon Wook ; Oh, Yun Kyu ; Lim, Chun Soo ; Kang, Shin Wook ; Kim, Yon Su ; Park, Jung Tak ; Lee, Jung Pyo. / Early initiation of continuous renal replacement therapy improves survival of elderly patients with acute kidney injury : A multicenter prospective cohort study. In: Critical Care. 2016 ; Vol. 20, No. 1.
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abstract = "Background: Continuous renal replacement therapy (CRRT) is essential in the management of critically ill patients with acute kidney injury (AKI). However, the optimal timing for initiating CRRT remains controversial, especially in elderly patients. Therefore, we investigated the outcomes of early CRRT initiation in elderly patients with AKI. Methods: A total of 607 patients ≥65 years of age who started CRRT due to AKI between August 2009 and December 2013 were prospectively enrolled. They were divided into two groups based on the median 6-hour urine output immediately before CRRT initiation. Propensity score matching was used to compare the overall survival rate, CRRT duration, and hospitalization duration. Results: The median age of both groups was 73.0 years, and 60 {\%} of the patients were male. The most common cause of AKI was sepsis. In the early CRRT group, the mean arterial pressure was higher, but the prothrombin time and total bilirubin, aspartate aminotransferase, and alanine aminotransferase levels were lower. The overall cumulative survival rate was higher in the early CRRT group (log-rank P < 0.01). Late CRRT initiation was associated with a higher mortality rate than early initiation after adjusting for age, sex, the Charlson comorbidity index, systolic arterial pressure, prothrombin time, the total bilirubin, aspartate aminotransferase, and alanine aminotransferase levels, cumulative fluid balance and diuretic use (hazard ratio, 1.35; 95 {\%} confidence interval 1.06, 1.71, P = 0.02). Following propensity score matching, patient survival was significantly better in the early CRRT group than in the late CRRT group (P < 0.01). The total duration of hospitalization from the start of CRRT was shorter among the survivors when CRRT was started earlier (26.7 versus 39.1 days, P = 0.04). Conclusion: A better prognosis can be expected if CRRT is applied early in the course of AKI in critically ill, elderly patients.",
author = "Park, {Jae Yoon} and An, {Jung Nam} and Jhee, {Jong Hyun} and Kim, {Dong Ki} and Oh, {Hyung Jung} and Sejoong Kim and Joo, {Kwon Wook} and Oh, {Yun Kyu} and Lim, {Chun Soo} and Kang, {Shin Wook} and Kim, {Yon Su} and Park, {Jung Tak} and Lee, {Jung Pyo}",
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Early initiation of continuous renal replacement therapy improves survival of elderly patients with acute kidney injury : A multicenter prospective cohort study. / Park, Jae Yoon; An, Jung Nam; Jhee, Jong Hyun; Kim, Dong Ki; Oh, Hyung Jung; Kim, Sejoong; Joo, Kwon Wook; Oh, Yun Kyu; Lim, Chun Soo; Kang, Shin Wook; Kim, Yon Su; Park, Jung Tak; Lee, Jung Pyo.

In: Critical Care, Vol. 20, No. 1, 260, 16.08.2016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Early initiation of continuous renal replacement therapy improves survival of elderly patients with acute kidney injury

T2 - A multicenter prospective cohort study

AU - Park, Jae Yoon

AU - An, Jung Nam

AU - Jhee, Jong Hyun

AU - Kim, Dong Ki

AU - Oh, Hyung Jung

AU - Kim, Sejoong

AU - Joo, Kwon Wook

AU - Oh, Yun Kyu

AU - Lim, Chun Soo

AU - Kang, Shin Wook

AU - Kim, Yon Su

AU - Park, Jung Tak

AU - Lee, Jung Pyo

PY - 2016/8/16

Y1 - 2016/8/16

N2 - Background: Continuous renal replacement therapy (CRRT) is essential in the management of critically ill patients with acute kidney injury (AKI). However, the optimal timing for initiating CRRT remains controversial, especially in elderly patients. Therefore, we investigated the outcomes of early CRRT initiation in elderly patients with AKI. Methods: A total of 607 patients ≥65 years of age who started CRRT due to AKI between August 2009 and December 2013 were prospectively enrolled. They were divided into two groups based on the median 6-hour urine output immediately before CRRT initiation. Propensity score matching was used to compare the overall survival rate, CRRT duration, and hospitalization duration. Results: The median age of both groups was 73.0 years, and 60 % of the patients were male. The most common cause of AKI was sepsis. In the early CRRT group, the mean arterial pressure was higher, but the prothrombin time and total bilirubin, aspartate aminotransferase, and alanine aminotransferase levels were lower. The overall cumulative survival rate was higher in the early CRRT group (log-rank P < 0.01). Late CRRT initiation was associated with a higher mortality rate than early initiation after adjusting for age, sex, the Charlson comorbidity index, systolic arterial pressure, prothrombin time, the total bilirubin, aspartate aminotransferase, and alanine aminotransferase levels, cumulative fluid balance and diuretic use (hazard ratio, 1.35; 95 % confidence interval 1.06, 1.71, P = 0.02). Following propensity score matching, patient survival was significantly better in the early CRRT group than in the late CRRT group (P < 0.01). The total duration of hospitalization from the start of CRRT was shorter among the survivors when CRRT was started earlier (26.7 versus 39.1 days, P = 0.04). Conclusion: A better prognosis can be expected if CRRT is applied early in the course of AKI in critically ill, elderly patients.

AB - Background: Continuous renal replacement therapy (CRRT) is essential in the management of critically ill patients with acute kidney injury (AKI). However, the optimal timing for initiating CRRT remains controversial, especially in elderly patients. Therefore, we investigated the outcomes of early CRRT initiation in elderly patients with AKI. Methods: A total of 607 patients ≥65 years of age who started CRRT due to AKI between August 2009 and December 2013 were prospectively enrolled. They were divided into two groups based on the median 6-hour urine output immediately before CRRT initiation. Propensity score matching was used to compare the overall survival rate, CRRT duration, and hospitalization duration. Results: The median age of both groups was 73.0 years, and 60 % of the patients were male. The most common cause of AKI was sepsis. In the early CRRT group, the mean arterial pressure was higher, but the prothrombin time and total bilirubin, aspartate aminotransferase, and alanine aminotransferase levels were lower. The overall cumulative survival rate was higher in the early CRRT group (log-rank P < 0.01). Late CRRT initiation was associated with a higher mortality rate than early initiation after adjusting for age, sex, the Charlson comorbidity index, systolic arterial pressure, prothrombin time, the total bilirubin, aspartate aminotransferase, and alanine aminotransferase levels, cumulative fluid balance and diuretic use (hazard ratio, 1.35; 95 % confidence interval 1.06, 1.71, P = 0.02). Following propensity score matching, patient survival was significantly better in the early CRRT group than in the late CRRT group (P < 0.01). The total duration of hospitalization from the start of CRRT was shorter among the survivors when CRRT was started earlier (26.7 versus 39.1 days, P = 0.04). Conclusion: A better prognosis can be expected if CRRT is applied early in the course of AKI in critically ill, elderly patients.

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U2 - 10.1186/s13054-016-1437-8

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