Urine output is associated with prognosis in patients with acute kidney injury requiring continuous renal replacement therapy

Hyung Jung Oh, Dong Ho Shin, Mi Jung Lee, Kwang Il Ko, Chan Ho Kim, Hyang Mo Koo, Fa Mee Doh, Young Eun Kwon, Yung Ly Kim, Ki Heon Nam, Kyoung Sook Park, Seong Yeong An, Jung Tak Park, Seung Hyeok Han, Tae Hyun Yoo, Shin Wook Kang

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Purpose: Although some studies have found that early initiation of continuous renal replacement therapy (CRRT) is associated with better prognosis, no consensus exists on the best timing to start CRRT. We investigated whether the timing of CRRT initiation was relevant to overall mortality and explored which factors at the time of CRRT initiation were associated with better outcomes in critically ill patients with acute kidney injury (AKI). Materials and Methods: A total of 361 patients who received CRRT for AKI between 2009 and 2011 were collected and divided into 2 groups based on the median blood urea nitrogen (BUN) levels or 6-hour urine output immediately before CRRT was started. The impact of the timing of CRRT initiation stratified by BUN concentration or urine output on 28-day all-cause mortality was compared between groups. Results: When the timing of CRRT initiation was stratified by 6-hour urine output, 28-day all-cause mortality rates were significantly lower in the nonoliguric group compared with the oliguric group (P = .02). In contrast, clinical outcomes were not different between the low-BUN and the high-BUN groups (P = .30). Cox regression analysis revealed that 28-day all-cause mortality risk was significantly lower in the nonoliguric group stratified by 6-hour urine output, even after adjusting for age, sex, mean arterial pressure, Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and serum biomarkers (hazard ratio, 0.85; 95% confidence interval, 0.65-0.99; P = .04). Conclusions: Urine output but not BUN concentration was significantly associated with a better prognosis in critically ill patients with AKI requiring CRRT.

Original languageEnglish
Pages (from-to)379-388
Number of pages10
JournalJournal of Critical Care
Volume28
Issue number4
DOIs
Publication statusPublished - 2013 Aug 1

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Renal Replacement Therapy
Acute Kidney Injury
Urine
Blood Urea Nitrogen
Mortality
Critical Illness
Organ Dysfunction Scores
APACHE
Arterial Pressure
Biomarkers
Regression Analysis
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Oh, Hyung Jung ; Shin, Dong Ho ; Lee, Mi Jung ; Ko, Kwang Il ; Kim, Chan Ho ; Koo, Hyang Mo ; Doh, Fa Mee ; Kwon, Young Eun ; Kim, Yung Ly ; Nam, Ki Heon ; Park, Kyoung Sook ; An, Seong Yeong ; Park, Jung Tak ; Han, Seung Hyeok ; Yoo, Tae Hyun ; Kang, Shin Wook. / Urine output is associated with prognosis in patients with acute kidney injury requiring continuous renal replacement therapy. In: Journal of Critical Care. 2013 ; Vol. 28, No. 4. pp. 379-388.
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title = "Urine output is associated with prognosis in patients with acute kidney injury requiring continuous renal replacement therapy",
abstract = "Purpose: Although some studies have found that early initiation of continuous renal replacement therapy (CRRT) is associated with better prognosis, no consensus exists on the best timing to start CRRT. We investigated whether the timing of CRRT initiation was relevant to overall mortality and explored which factors at the time of CRRT initiation were associated with better outcomes in critically ill patients with acute kidney injury (AKI). Materials and Methods: A total of 361 patients who received CRRT for AKI between 2009 and 2011 were collected and divided into 2 groups based on the median blood urea nitrogen (BUN) levels or 6-hour urine output immediately before CRRT was started. The impact of the timing of CRRT initiation stratified by BUN concentration or urine output on 28-day all-cause mortality was compared between groups. Results: When the timing of CRRT initiation was stratified by 6-hour urine output, 28-day all-cause mortality rates were significantly lower in the nonoliguric group compared with the oliguric group (P = .02). In contrast, clinical outcomes were not different between the low-BUN and the high-BUN groups (P = .30). Cox regression analysis revealed that 28-day all-cause mortality risk was significantly lower in the nonoliguric group stratified by 6-hour urine output, even after adjusting for age, sex, mean arterial pressure, Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and serum biomarkers (hazard ratio, 0.85; 95{\%} confidence interval, 0.65-0.99; P = .04). Conclusions: Urine output but not BUN concentration was significantly associated with a better prognosis in critically ill patients with AKI requiring CRRT.",
author = "Oh, {Hyung Jung} and Shin, {Dong Ho} and Lee, {Mi Jung} and Ko, {Kwang Il} and Kim, {Chan Ho} and Koo, {Hyang Mo} and Doh, {Fa Mee} and Kwon, {Young Eun} and Kim, {Yung Ly} and Nam, {Ki Heon} and Park, {Kyoung Sook} and An, {Seong Yeong} and Park, {Jung Tak} and Han, {Seung Hyeok} and Yoo, {Tae Hyun} and Kang, {Shin Wook}",
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Oh, HJ, Shin, DH, Lee, MJ, Ko, KI, Kim, CH, Koo, HM, Doh, FM, Kwon, YE, Kim, YL, Nam, KH, Park, KS, An, SY, Park, JT, Han, SH, Yoo, TH & Kang, SW 2013, 'Urine output is associated with prognosis in patients with acute kidney injury requiring continuous renal replacement therapy', Journal of Critical Care, vol. 28, no. 4, pp. 379-388. https://doi.org/10.1016/j.jcrc.2012.11.019

Urine output is associated with prognosis in patients with acute kidney injury requiring continuous renal replacement therapy. / Oh, Hyung Jung; Shin, Dong Ho; Lee, Mi Jung; Ko, Kwang Il; Kim, Chan Ho; Koo, Hyang Mo; Doh, Fa Mee; Kwon, Young Eun; Kim, Yung Ly; Nam, Ki Heon; Park, Kyoung Sook; An, Seong Yeong; Park, Jung Tak; Han, Seung Hyeok; Yoo, Tae Hyun; Kang, Shin Wook.

In: Journal of Critical Care, Vol. 28, No. 4, 01.08.2013, p. 379-388.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Urine output is associated with prognosis in patients with acute kidney injury requiring continuous renal replacement therapy

AU - Oh, Hyung Jung

AU - Shin, Dong Ho

AU - Lee, Mi Jung

AU - Ko, Kwang Il

AU - Kim, Chan Ho

AU - Koo, Hyang Mo

AU - Doh, Fa Mee

AU - Kwon, Young Eun

AU - Kim, Yung Ly

AU - Nam, Ki Heon

AU - Park, Kyoung Sook

AU - An, Seong Yeong

AU - Park, Jung Tak

AU - Han, Seung Hyeok

AU - Yoo, Tae Hyun

AU - Kang, Shin Wook

PY - 2013/8/1

Y1 - 2013/8/1

N2 - Purpose: Although some studies have found that early initiation of continuous renal replacement therapy (CRRT) is associated with better prognosis, no consensus exists on the best timing to start CRRT. We investigated whether the timing of CRRT initiation was relevant to overall mortality and explored which factors at the time of CRRT initiation were associated with better outcomes in critically ill patients with acute kidney injury (AKI). Materials and Methods: A total of 361 patients who received CRRT for AKI between 2009 and 2011 were collected and divided into 2 groups based on the median blood urea nitrogen (BUN) levels or 6-hour urine output immediately before CRRT was started. The impact of the timing of CRRT initiation stratified by BUN concentration or urine output on 28-day all-cause mortality was compared between groups. Results: When the timing of CRRT initiation was stratified by 6-hour urine output, 28-day all-cause mortality rates were significantly lower in the nonoliguric group compared with the oliguric group (P = .02). In contrast, clinical outcomes were not different between the low-BUN and the high-BUN groups (P = .30). Cox regression analysis revealed that 28-day all-cause mortality risk was significantly lower in the nonoliguric group stratified by 6-hour urine output, even after adjusting for age, sex, mean arterial pressure, Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and serum biomarkers (hazard ratio, 0.85; 95% confidence interval, 0.65-0.99; P = .04). Conclusions: Urine output but not BUN concentration was significantly associated with a better prognosis in critically ill patients with AKI requiring CRRT.

AB - Purpose: Although some studies have found that early initiation of continuous renal replacement therapy (CRRT) is associated with better prognosis, no consensus exists on the best timing to start CRRT. We investigated whether the timing of CRRT initiation was relevant to overall mortality and explored which factors at the time of CRRT initiation were associated with better outcomes in critically ill patients with acute kidney injury (AKI). Materials and Methods: A total of 361 patients who received CRRT for AKI between 2009 and 2011 were collected and divided into 2 groups based on the median blood urea nitrogen (BUN) levels or 6-hour urine output immediately before CRRT was started. The impact of the timing of CRRT initiation stratified by BUN concentration or urine output on 28-day all-cause mortality was compared between groups. Results: When the timing of CRRT initiation was stratified by 6-hour urine output, 28-day all-cause mortality rates were significantly lower in the nonoliguric group compared with the oliguric group (P = .02). In contrast, clinical outcomes were not different between the low-BUN and the high-BUN groups (P = .30). Cox regression analysis revealed that 28-day all-cause mortality risk was significantly lower in the nonoliguric group stratified by 6-hour urine output, even after adjusting for age, sex, mean arterial pressure, Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and serum biomarkers (hazard ratio, 0.85; 95% confidence interval, 0.65-0.99; P = .04). Conclusions: Urine output but not BUN concentration was significantly associated with a better prognosis in critically ill patients with AKI requiring CRRT.

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U2 - 10.1016/j.jcrc.2012.11.019

DO - 10.1016/j.jcrc.2012.11.019

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VL - 28

SP - 379

EP - 388

JO - Journal of Critical Care

JF - Journal of Critical Care

SN - 0883-9441

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