Classical Indications Are Useful for Initiating Continuous Renal Replacement Therapy in Critically Ill Patients

Lee, Jeonghwan; Cho, Jang‐Hee; Chung, Byung Ha; Park, Sun-Hee; Lee, Jung Pyo; Chang, Jae Hyun; Kim, Yon Su; Kim, Sejoong

doi:10.1620/tjem.233.233

Cited by 3 publications

(2 citation statements)

References 41 publications

(49 reference statements)

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“…discordance in the findings of these two well-designed RCTs highlights the need for a standardized approach to clinical decision support regarding dialysis initiation. In our study, we implemented a decision-making algorithm on the basis of aggregated findings in the established literature (4)(5)(6)(7)(8)(9). On the basis of the limitations of previous studies and the absence of clear guidelines about RRT initiation and discontinuation, we recognized the importance of allowing nephrologists to deviate from the SCAMP recommendations and sought to capture these reasons for deviation.…”

Section: Discussionmentioning

confidence: 99%

A Decision-Making Algorithm for Initiation and Discontinuation of RRT in Severe AKI

Mendu

Ciociolo²,

McLaughlin³

et al. 2017

CJASN

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Section: Discussionmentioning

confidence: 99%

A Decision-Making Algorithm for Initiation and Discontinuation of RRT in Severe AKI

Mendu

Ciociolo²,

McLaughlin³

et al. 2017

CJASN

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“…Although the optimal timing of CRRT initiation remains controversial, recent studies comparing early and late initiation have suggested that early initiation may have a beneficial impact on survival of critically ill patients with AKI. [16,17,18] However, in managing septic AKI, whether to provide renal-replacement therapy and, if so, when to initiate it are unclear.…”

Section: Introductionmentioning

confidence: 99%

Timing of continuous renal replacement therapy in patients with septic AKI

Zhang

2019

Medicine

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Background:The effects of early continuous renal replacement therapy (CRRT) on mortality in patients with septic acute kidney injury (AKI) remain controversial. A systematic review and meta-analysis was performed to investigate the impact of timing of CRRT on clinical outcomes in patients with septic AKI.Methods:The PubMed, Cochrane, and Embase databases were searched from inception to the 31st of March 2019, to identify trials that assessed the timing of initiation of CRRT in patients with septic AKI.Results:Five trials including 900 patients were included. The results of this meta-analysis showed that there was no significant difference between 28-day mortality (odds ratio = 0.76;95% CI, 0.58–1.00; P = .05) and 90-day mortality(odds ratio = 0.79;95% CI, 0.59–1.06; P = .12)of early and late initiation of CRRT group. In addition, compared with late initiation strategy, early initiation showed no significant advantage in length of stay in ICU (Mean difference = −0.9;95% CI, −2.37 to 0.57; P = .23) and length of stay in hospital (Mean difference = −1.43;95% CI, −5.28 to 2.41; P = .47).Conclusion:Our meta-analysis revealed that early initiation of CRRT could not reduce mortality in patients with septic AKI. The study also showed no significant difference in ICU length of stay or hospital length of stay between early and late CRRT group. To achieve optimal timing of CRRT for septic AKI, large multicenter randomized trials with better design are still needed.

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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

Jhee

et al. 2016

Crit Care

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BackgroundContinuous 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.MethodsA 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.ResultsThe 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).ConclusionA better prognosis can be expected if CRRT is applied early in the course of AKI in critically ill, elderly patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1437-8) contains supplementary material, which is available to authorized users.

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Classical Indications Are Useful for Initiating Continuous Renal Replacement Therapy in Critically Ill Patients

Cited by 3 publications

References 41 publications

A Decision-Making Algorithm for Initiation and Discontinuation of RRT in Severe AKI

A Decision-Making Algorithm for Initiation and Discontinuation of RRT in Severe AKI

Timing of continuous renal replacement therapy in patients with septic AKI

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

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