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

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• 作者：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
• 关键词：Acute kidney injury ; Continuous renal replacement therapy ; 28-Day mortality ; Urine output ; Blood urea nitrogen
• 刊名：Journal of Critical Care
• 出版年：2013
• 出版时间：August, 2013
• 年：2013
• 卷：28
• 期：4
• 页码：379-388
• 全文大小：531 K

文摘

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.