Early initiation of dialysis: mortality and renal function recovery in acute kidney injury patient

Abstract

Introduction:The decision of when to start dialysis in Acute Kidney Injury (AKI) patients with overt uremia is strongly established, however, when blood urea nitrogen (BUN) levels is < 100 mg/dL the timing of initiation of dialysis remains uncertain. Purpose: The aim of this study was to assess mortality and renal function recovery AKI patients started on dialysis at different BUN levels. Methods: This was a retrospective study performed at Medical School Hospital, São Paulo, Brazil, enrolling 86 patients underwent to dialysis. Results: Dialysis was started when BUN ≤ 75 mg/dl in 23 patients (Group I) and BUN > 75 mg/dl in 63 patients (Group II). Hypervolemia and mortality were higher in Group I than in Group II (65.2% vs. 14.3% -p < 0.05, 39.1% vs. 68.9%-p < 0.05, respectively). Among survivors, the rate of renal function recovery was higher in Group I (71.4% and 36.8%, respectively -p < 0.05). Multivariate analysis showed that sepsis, age > 60 years, peritoneal dialysis and BUN > 75 mg/dl at dialysis initiation were independently related with mortality. Conclusions: Lower mortality and higher renal function recovery rates were associated with early dialysis initiated at lower BUN leves in AKI patients.Início precoce da diálise: mortalidade e recuperação da função renal em pacientes com lesão renal aguda Early initiation of dialysis: mortality and renal function recovery in acute kidney injury patients AbstRAct Palavras-chave: diálise, insuficiência renal, lesão renal aguda, mortalidade.

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

“…Only limited high quality data exist on the effects of operational characteristics of RRT on recovery of kidney function among patients with RRT-dependent AKD 87,[118][119][120][121][122][123] (BOX 5; TABLE 2). Findings from a single randomized trial suggest that utilization of strict guidelines to improve therapy tolerance and metabolic control renders intermittent RRT comparable to continuous RRT 123 .…”

Early start renal replacement therapy for acute kidney injury—Universal panacea or another case of over medicalization?

“…In addition, patient comorbidity and other potential confounders were not adequately described in these trials, and so, for example, although Elahi and colleagues reported greater mortality with later start of RRT, this group had considerably more diabetic patients . Similarly, a study from Brazil reported better survival with earlier initiation, but lower survival was also associated with increasing patient age, sepsis, and choice of peritoneal dialysis …”

“…In addition, the incidence of AKI is greater for patients with pre‐existing chronic kidney disease, in particular the elderly, and those with higher comorbidity scores including diabetic patients and those with congestive cardiac failure. As such, patients with little pre‐existing comorbidity and community‐acquired AKI have reported mortality rates of 20% or less, whereas mortality rates can be higher than 70% for AKI in older patients admitted to the intensive care unit (ICU) …”

“…As such, patients with little pre-existing comorbidity and community-acquired AKI have reported mortality rates of 20% or less, 1 whereas mortality rates can be higher than 70% for AKI in older patients admitted to the intensive care unit (ICU). 2 Once dialysis became available for the treatment of AKI, then the key question: "when to initiate?" treatment remains open more than 50 years later.…”

Initiation time of renal replacement therapy on patients with acute kidney injury: A systematic review and meta‐analysis of 8179 participants

“…Continued) 95% CI) 0.74 [0.68, 0.81] 71%, <0.001[18][19][20][21][22]46,48,49,[52][53][54]56,[58][59][60][61][62][63][64][65] All-cause mortality for AKI by sample size <0.00119,24,25,28,29,31,32,36,37,[40][41][42][43][46][47][48][49][50][51][52][55][56][57]61,[63][64][65] …”