The optimal timing of continuous renal replacement therapy for patients with sepsis-induced acute kidney injury

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• 作者：Huanhuan Tian ; Ting Sun ; Dong Hao ; Tao Wang ; Zhi Li…
• 关键词：Sepsis ; induced acute kidney injury ; Continuous blood purification ; Acute kidney injury network ; Renal recovery
• 刊名：International Urology and Nephrology
• 出版年：2014
• 出版时间：October 2014
• 年：2014
• 卷：46
• 期：10
• 页码：2009-2014
• 全文大小：321 KB
• 参考文献：1. Bagshaw SM, Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N (2007) Beginning and ending supportive therapy for the kidney (BEST Kidney) investigators: Septic acute kidney injury in critically ill patients: clinical characteristics and outcomes. Clin J Am Soc Nephrol 2(3):431-39 CrossRef
  2. Bagshaw SM, George C, Bellomo R (2008) Early acute kidney injury and sepsis: a multicentre evaluation. Crit Care 12(2):R47 CrossRef
  3. Nakada T-a, Oda S, Matsuda K-i, Sadahiro T, Nakamura M, Abe R, Hirasawa H (2008) Continuous hemodiafiltration with PMMA hemofilter in the treatment of patients with septic shock. Mol Med 14(5-):257
  4. Cohen J (2002) The immunopathogenesis of sepsis. Nature 420(6917):885-91 CrossRef
  5. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345(19):1368-377 CrossRef
  6. Tracey KJ (2007) Physiology and immunology of the cholinergic antiinflammatory pathway. J Clin Investig 117(2):289-96 CrossRef
  7. Liu KD, Himmelfarb J, Paganini E, Ikizler TA, Soroko SH, Mehta RL, Chertow GM (2006) Timing of initiation of dialysis in critically ill patients with acute kidney injury. Clin J Am Soc Nephrol 1(5):915-19 CrossRef
  8. Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, La Greca G (2000) Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet 356(9223):26-0 CrossRef
  9. Bagshaw SM, Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N (2009) Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury. J Crit Care 24(1):129-40 CrossRef
  10. Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C (2006) An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med 34(7):1913-917 CrossRef
  11. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A (2007) Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11(2):R31 CrossRef
  12. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent J-L, Ramsay G (2003) 2001 sccm/esicm/accp/ats/sis international sepsis definitions conference. Intensive Care Med 29(4):530-38 CrossRef
  13. Vincent J-L, Moreno R, Takala J, Willatts S, De Mendon?a A, Bruining H, Reinhart C, Suter P, Thijs L (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 22(7):707-10 CrossRef
  14. Shiao C-C, Wu V-C, Li W-Y, Lin Y-F, Hu F-C, Young G-H, Kuo C-C, Kao T-W, Huang D-M, Chen Y-M (2009) Late initiation of renal replacement therapy is associated with worse outcomes in acute kidney injury after major abdominal surgery. Crit Care 13(5):R171 CrossRef
  15. Li W-X, Chen H-D, Wang X-W, Zhao S, Chen X-K, Zheng Y, Song Y (2009) Predictive value of RIFLE classification on prognosis of critically ill patients with acute kidney injury treated with continuous renal replacement therapy. Chin Med J (Engl) 122(9):1020-025
  
• 作者单位：Huanhuan Tian (1)
  Ting Sun (1)
  Dong Hao (1)
  Tao Wang (1)
  Zhi Li (1)
  Shasha Han (1)
  Zhijiang Qi (1)
  Zhaoju Dong (2)
  Changjun Lv (1)
  Xiaozhi Wang (1)
  
  1. Intensive Care Unit, Affiliated Hospital of Binzhou Medical University, 661 Yellow River Road, Binzhou, 256603, Shandong, People’s Republic of China
  2. Healthy Administration College, Binzhou Medical University, Binzhou, People’s Republic of China
  
• ISSN：1573-2584

文摘

Purpose High mortality in the intensive care unit (ICU) is probably associated with sepsis-induced acute kidney injury (AKI). The aim of this study is to explore which stage of AKI may be the optimal timing for continuous renal replacement therapy (CRRT). Methods A retrospective analysis of 160 critically ill patients with septic AKI, treated with or without CRRT was performed in Binzhou medical college affiliated hospital ICU. The parameters including 28-days mortality rate, renal recovery, ventilation time and ICU stay between CRRT group and control group were assessed. Results Renal recovery, defined as independence from dialysis at discharge, was documented for 64/76 (84.2?%) of the surviving patients (48.1?% of total subjects included in the study). The mortality rate increased proportionally with acute kidney injury Network stages in CRRT subgroups (P?=?0.001) and control groups (P?=?0.029). CRRT initiation at stage 2 of AKI significantly reduced the 28-day mortality (P?=?0.048) and increased the 28-day survival rate (P?=?0.036) compared with those in control group. In addition, the ICU stay and ventilation time were shorter in CRRT group than that of control group in stage 2 of AKI. Conclusion The stage 2 AKI might be the optimal timing for performing CRRT.