Continuous renal replacement therapy for the treatment of acute kidney injury

Abstract

Background/Aims : Continuous renal replacement therapy (CRRT) has been widely used for treating critically ill patients with acute kidney injury (AKI). Whether CRRT is better than intermittent hemodialysis for the treatment of AKI remains controversial. We sought to identify the clinical features that can predict survival for the patients who are treated with CRRT.Methods : We analyzed the data of 125 patients who received CRRT between 2005 and 2007. We identified the demographic variables, the underlying diagnoses, the duration of CRRT, the mean arterial blood pressure (ABP) and the Simplified Acute Physiology Score (SAPS) II. The classification/staging system for acute kidney injury (AKI) was applied to all the patients, who were then divided into stage 1-3 subgroups.Results : The average age of the patients was 61.414.3 years and the mortality rate was 60% (75 of 125 patients). The survivors had a significantly higher mean ABP and a higher mean serum bicarbonate level, which were measured the day after CRRT, than the nonsurvivors (86.723.7 vs. 69.224.6 mm Hg, respectively, 21.43.5 vs. 16.45.4 mmol/L, respectively,; p<0.05 for each). The stage 3 AKI patients showed the worst parameters for the SAPS II score and the serum levels of creatinine and blood urea nitrogen. The mortality rate was higher for the stage 3 subgroup than the other groups (70.5%, p<0.05).Conclusions : The patients with AKI and who require CRRT continue to have a high mortality rate. A higher mean ABP and a higher serum bicarbonate level measured the day after CRRT may predict a more favorable prognosis. The staging system for AKI can improve the ability to predict the outcomes of CRRT patients.

Factors Associated with Early Mortality in Critically Ill Patients Following the Initiation of Continuous Renal Replacement Therapy

“…Several studies report a significant association between a high SOFA score at CRRT initiation, and increased mortality [ 38 , 39 , 40 ]. Arterial pH is one of the variables that is considered in the APACHE II score, which was designed to measure the disease severity and the risk of death in critically ill patients, and several studies have demonstrated that arterial pH is associated with increased mortality in patients undergoing CRRT [ 41 , 42 , 43 ]. In addition, previous studies have reported that hypernatremia and hyperphosphatemia are common in critically ill patients, and they were associated with increased morbidity and mortality [ 44 , 45 , 46 , 47 ].…”

Risk factors for mortality in patients with acute kidney injury and hypotension treated with continuous veno-venous hemodiafiltration

“…Several previous trials have investigated the prognostic factors for mortality of patients undergoing CRRT; these studies found different prognostic factors [8] , [10] , [11] . One study showed that metabolic acidosis and earlier initiation of CRRT were associated with the survival of patients with AKI receiving CRRT [10] .…”

“…Bouman et al [13] defined early hemofiltration as treatment started when urine output is decreased <30 mL/hour for over 6 hours and reported that early dialysis did not affect mortality. Bae et al [11] reported that lower mean arterial blood pressure and lower serum bicarbonate levels measured the day after CRRT may predict a poor prognosis. These conflicting results might be caused by differences in disease severity and study populations, because we examined prognostic factors in a group with more severe disease and hemodynamic instability.…”

“…Although previous studies have identified several prognostic factors for mortality associated with CRRT, such as sepsis, higher APACHE II scores, oliguric AKI, the presence of coma, higher SOFA scores, and the need for mechanical ventilation in critically ill patients undergoing CRRT, each study found different results according to the indication for CRRT and the severity of the disease [6] , [7] , [8] , [9] , [10] , [11] . Therefore, the prognostic factors for patients requiring CRRT still remain somewhat obscure.…”

Cumulative fluid balance and mortality in elderly patients with acute kidney injury requiring continuous renal-replacement therapy: a multicenter prospective cohort study

“…Continuous renal-replacement therapy (CRRT) has become an essential strategy for the management of critically ill patients with acute kidney injury (AKI) [ 1 , 2 ]. Previous research has identified several prognostic factors for mortality—including sepsis, higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, oliguria, higher Sequential Organ Failure Assessment (SOFA) score, and the need for mechanical ventilation—in patients with severe AKI undergoing CRRT [ 3 - 6 ]. However, predicting the outcome of patients requiring CRRT remains a challenge.…”