Effect of timing of dialysis on mortality in critically ill, septic patients with acute renal failure

Abstract

Acute renal failure with concomitant sepsis in the intensive care unit is associated with significant mortality. The purpose of this study was to determine if the timing of initiation of renal replacement therapy (RRT) in septic patients had an effect on the 28-day mortality. Retrospective data on medical intensive care unit patients with sepsis and acute renal failure requiring RRT were included. Renal replacement therapy started with a blood urea nitrogen (BUN) of <100 mg/dL was defined as "early" initiation, and initiation with a BUN >or=100 mg/dL was defined as "late." Multivariate logistic regression analysis with the primary outcome of death at 14, 28, and 365 days following the initiation of RRT was performed. One hundred thirty patients were studied. The early dialysis (mean BUN 66 mg/dL) group had 85 patients; the late group (mean BUN 137 mg/dL) had 62 patients. The mean acute physiology and chronic health evaluation II score was 24.5 in both groups. The overall 14, 28, and 365-day survival rates were 58.1%, 41.9%, and 23.6%. Survival rates for the early group were 67%, 47.7%, and 30.7% at 14, 28, and 365 days. Survival rates for the late group were 46.7%, 31.7%, and 13.3% at 14, 28, and 365 days. Upon logistic regression analysis, initiating dialysis with a BUN >100 mg/dL predicted death at 14 days (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.7-7.6, P=0.001), 28 days (OR 2.6, 95% CI 1.2-5.7, P=0.01), and 365 days (OR 3.5, 95% CI 1.2-10, P=0.02). Septic patients who started dialysis with a BUN <100 mg/dL had improved mortality rates up to 1 year after initiation of dialysis in this single-center, retrospective analysis.

Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version

“…However, there was no significant difference in the recovery of kidney function by the timing of the initiation of dialysis. Similar results were obtained in a recent cohort study [193]. In a large-scale cohort study of critically ill patients with severe AKI in whom RRT was initiated on the basis of BUN and SCr levels, there was no significant difference in mortality between patients undergoing early (BUN \67.76 mg/dL) and late (BUN C67.76 mg/dL) RRT, and late RRT was associated with a longer duration of RRT [194].…”

Secular trends in acute dialysis after elective major surgery — 1995 to 2009

“…[28][29][30][31] This last practice may have been influenced by recent studies suggesting that starting dialysis earlier may improve prognosis. 29,[32][33][34][35] Unfortunately, despite the trends in increasing use of dialysis and starting it earlier, survival has remained poor. Unchanging mortality and rates of chronic dialysis also suggest these trends re flect a lower threshold for starting treatment.…”

Health status, renal function, and quality of life after multiorgan failure and acute kidney injury requiring renal replacement therapy

“…In contrast, Carl et al 25 reported only 24.6% 1-year survival in a septic study population with AKI. The in-hospital mortality was reported as 38%-69% in a recent review, 26 which matches with our result of ∼60%.…”