Early initiation renal replacement therapy for fluid management to reduce central venous pressure is more conducive to renal function recovery in patients with acute kidney injury

Abstract

Background: Acute kidney injury (AKI) is a serious complication in critically ill patients with septic shock treated in the intensive care unit. Renal replacement therapy (RRT) is a treatment for severe AKI; however, the time of initiation of RRT and factors that affect the recovery of kidney function remains unclear. This study was to explore whether early initiation of RRT treatment for fluid management to reduce central venous pressure (CVP) can help to improve patients’ kidney function recovery. Methods: A retrospective analysis of septic patients who had received RRT treatment was conducted. Patients received RRT either within 12 h after they met the diagnostic criteria of renal failure (early initiation) or after a delay of 48 h if renal recovery had not occurred (delayed initiation). Parameters such as patients’ renal function recovery at discharge, fluid balance, and levels of CVP were assessed. Results: A total of 141 patients were eligible for enrolment: 40.4% of the patients were in the early initiation group (57 of 141 patients), and 59.6% were in the delayed initiation group (84 of 141 patients). There were no significant differences in the characteristics at baseline between the two groups, and there were no differences in 28-day mortality between the two groups (χ 2 = 2.142, P = 0.143); however, there was a significant difference in the recovery rate of renal function between the two groups at discharge (χ 2 = 4.730, P < 0.001). More importantly, early initiation of RRT treatment and dehydration to reduce CVP are more conducive to the recovery of renal function in patients with AKI. Conclusion: Compared with those who received delayed initiation RRT, patients who received early-initiation RRT for dehydration to reduce CVP have enhanced kidney function recovery.

Early versus late initiation of renal replacement therapy impacts mortality in septic patients with acute kidney injury: a meta-analysis

“…4). In cohort studies [25][26][27][28][29][30][31] there was a statistically significant decrease in mortality among patients who received early RRT (OR 0.42; 95% CI 0.30 to 0.40; I 2 21%), while mortality in the RCTs [20,24](OR 1.1; 95% CI 0.84 to 1.45; I 2 0%) was not statistically significant.…”

“…Nine studies [20,[24][25][26][27][28][29][30][31] with a total of 1694 patients ultimately met our criteria (Table 1). These references included two RCTs [20,24] and seven retrospective cohort studies [25][26][27][28][29][30][31]. The characteristics and methodological quality of all trials in the meta-analysis are shown in Table 1 and the outcomes in septic patients with AKI are shown in Table 2.…”

“…The quality of seven cohort studies [25][26][27][28][29][30][31] were evaluated using the Newcastle-Ottawa Scale (NOS) (range 0-9, with 9 indicating the highest quality) ( Table 1).…”

“…Besides, in another subgroup analysis based on different time of starting early RRT included seven studies [20,[24][25][26][27][28]30] (Fig. 5), while two of the excluded studies were not referred to time cutoffs [29,31].…”

“…Seven studies [20,24,25,[28][29][30][31] of the included articles described that the ICU LOS (MD -1.49 days;…”