Initiating acute dialysis at earlier <scp>A</scp>cute <scp>K</scp>idney <scp>I</scp>njury <scp>N</scp>etwork stage in critically ill patients without traditional indications does not improve outcome: A prospective cohort study

Lim, Cynthia Ciwei; Tan, Chieh Suai; Kaushik, Manish; Tan, Han Khim

doi:10.1111/nep.12364

Cited by 26 publications

(22 citation statements)

References 38 publications

(71 reference statements)

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“…Therefore, blood purification technology could be used to remove inflammatory factors, eliminate cytokine storm, correct electrolyte imbalance, and maintain acid-base balance, to control patient's capacity load in an effective manner [65]. In this logic, the patient's symptoms could be improved and the blood oxygen saturation could be increased.…”

Section: Auxiliary Blood Purification Treatmentmentioning

confidence: 99%

Review of the 2019 novel coronavirus (SARS-CoV-2) based on current evidence

Wang

et al. 2020

International Journal of Antimicrobial Agents

978

815

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Section: Auxiliary Blood Purification Treatmentmentioning

confidence: 99%

Review of the 2019 novel coronavirus (SARS-CoV-2) based on current evidence

Wang

et al. 2020

International Journal of Antimicrobial Agents

978

815

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“…[28,29] Several studies showed high survival rates and kidney recovery among patients who received early RRT. [30–32] Recently, a single-center trial, [25] comparing early RRT with delayed RRT in patients with AKI trial, reported that early initiation resulted in a 15.4% reduction in 90-day mortality compared with delayed RRT (39.3% vs 53.6%; P = 0.03). For the early group, RRT was initiated within 8 hours of diagnosis of stage 2 AKI using the Kidney Disease: Improving Global Outcomes (KDIGO) classification, while delayed RRT was initiated within 12 hours of stage 3 AKI.…”

Section: Discussionmentioning

confidence: 99%

Early initiation of renal replacement treatment in patients with acute kidney injury

Wang

Li²,

Chu³

et al. 2016

Medicine

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Background:Acute kidney injury (AKI) is associated with a substantially increased risk of mortality for many hospitalized patients. It has been suggested that early initiation of renal replacement treatment has a favorable outcome in critically ill patients complicated with AKI. However, results of studies evaluating the effect of early initiation strategy of renal replacement treatment on AKI have been controversial and contradictory. The aim of this meta-analysis is to examine the effect of early initiation of renal replacement treatment on patients with AKI.Methods:The authors searched relevant studies in PubMed, EMBASE, and the Cochrane Library through August 2016. We searched for all eligible randomized controlled trials with regard to the role of early initiation of renal replacement treatment in mortality among patients with AKI. We extracted the following information from each study: mortality, length of stay in intensive care unit (ICU), and length of stay in hospital. Random and fixed effect models were used for pooling data.Results:Twelve trials including 1756 patients were included. The results of this meta-analysis showed that there was no significant difference between the mortality of early and delayed strategy for the initiation of renal replacement treatment using the random effect model (odds ratio = 0.78; 95% confidence interval [CI], 0.52–1.19; P = 0.25), with wild heterogeneity (chi2 = 33.50; I2 = 67%). Analyses from subgroup sepsis and postsurgery came to similar results. In addition, compared with delayed initiation strategy, early initiation showed no significant advantage in length of stay in ICU (mean difference = −0.80; 95% CI, −2.59 to 0.99; P = 0.56) and length of stay in hospital (mean difference = −7.69; 95% CI, −16.14 to 0.76; P = 0.07).Conclusion:According to the results from present meta-analysis, early initiation of renal replacement treatment showed no survival benefits in patients with AKI. To achieve optimal timing of renal replacement treatment, further large multicenter randomized trials, with widely accepted and standardized definition of early initiation, are still needed.

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“…This was a secondary analysis of prospectively collected data from a cohort study in a single-center 1782-bed tertiary-care hospital in Singapore [13]. All critically ill patients admitted to medical and surgical ICU between 18 December 2010 and 3 April 2013, who received acute RRT for AKI, were included.…”

Section: Methodsmentioning

confidence: 99%

Hypophosphatemia in critically ill patients with acute kidney injury treated with hemodialysis is associated with adverse events

2017

Self Cite

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Background. Hypophosphatemia in critically ill patients may be exacerbated by renal replacement therapy (RRT). We aimed to identify risk factors and adverse outcomes associated with hypophosphatemia in intensive care patients treated with RRT for acute kidney injury (AKI). Methods. This was a secondary analysis of data from a single-center prospective cohort study of medical and surgical intensive care patients with RRT for AKI between 18 December 2010 and 3 April 2013. Demographic, comorbidity, laboratory and RRT data were retrieved from patient case notes and electronic medical records. Outcomes assessed were hypophosphatemia (serum phosphate <0.94 mmol/L) during RRT, intensive care unit (ICU) mortality, and duration of mechanical ventilation and vasopressor support. Results. Among 96 patients who received acute RRT, 25 (26.0%) developed hypophosphatemia. On multivariate logistic regression, serum phosphate at RRT initiation [adjusted odds ratio (OR) 0.29, 95% confidence interval (CI) (0.09, 0.91), P = 0.03] was independently associated with hypophosphatemia during acute RRT. Patients with hypophosphatemia during RRT required longer ventilatory support [median 12 (interquartile range: 8, 17) days versus 5 (3, 9) days, P < 0.001] and vasopressor support [5 (4, 15) days versus 2 (2, 6) days, P = 0.003] compared with those without hypophosphatemia but there was no significant difference in ICU mortality [5 patients (20.0%) versus 24 patients (33.8%), P = 0.20]. Hypophosphatemia during RRT was independently associated with prolonged mechanical ventilation (≥7 days) [adjusted OR 14.0, 95% CI (1.37, 143.90), P = 0.03]. Conclusion. Hypophosphatemia is common during acute RRT for critically ill patients and was associated with adverse clinical outcomes.

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Initiating acute dialysis at earlier Acute Kidney Injury Network stage in critically ill patients without traditional indications does not improve outcome: A prospective cohort study

Abstract: Presence of traditional indications at ARRT initiation was associated with greater mortality. Initiating dialysis at earlier AKIN stage did not improve survival in patients without traditional indications.

Cited by 26 publications

References 38 publications

Review of the 2019 novel coronavirus (SARS-CoV-2) based on current evidence

Review of the 2019 novel coronavirus (SARS-CoV-2) based on current evidence

Early initiation of renal replacement treatment in patients with acute kidney injury

Hypophosphatemia in critically ill patients with acute kidney injury treated with hemodialysis is associated with adverse events

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