New, goal-directed approach to renal replacement therapy improves acute kidney injury treatment after cardiac surgery

Abstract

Aim: The aim of this study was to compare the efficacies of goal-directed renal replacement therapy (GDRRT) and daily hemofiltration (DHF) for treating acute kidney injury (AKI) patients after cardiac surgery. Methods: In our retrospective study, we included 140 cardiac surgery AKI patients who were treated with renal replacement therapy (RRT) from 2002 to 2010. Two patient groups, which comprised 70 patients who received DHF from January 2002 to September 2008 and 70 patients treated with GDRRT from October 2009 to September 2010 were pair-wise compared regarding clinical outcomes, as well as the incidence of adverse events.Results: In-hospital and 30-day mortality rates were 45.7% and 41.4% in the GDRRT and 48.6% and 54.3% in the DHF group, respectively, but without statistically significant differences. GDRRT patients needed statistically significantly shorter hospital and intensive care unit (ICU) stays, less frequent RRT, and shorter RRT sessions, whereas, of 11 analyzed renal outcome parameters, 6 values, including percentage of complete renal recovery and time for complete renal recovery, were significantly superior in the GDRRT group at the time of discharge. There was no significant difference in the incidence of adverse events within the initial 72 treatment hours between the 2 groups. Hospitalization expenses were less in GDRRT group than in DHF group. Conclusion:The GDRRT approach is superior to DHF for improving renal outcome, as well as reducing the time and cost of RRT therapy, for cardiac surgery AKI patients.

Acute kidney injury inChina

“…Various techniques for RRT, either intermittent or continuous, are available for patients with AKI. [60][61][62] A continuous approach to RRT (CRRT) for critically ill patients was introduced in 1977 and hailed almost immediately as an improved alternative to intermittent HD (IHD). CRRT was introduced to China in 1985, by Professor Liao Lvtan, the founder and the first director of the Department of Nephrology at Zhongshan Hospital Fudan University, and one of the main founders of blood purification technology in China.…”

“…Various techniques for RRT, either intermittent or continuous, are available for patients with AKI . A continuous approach to RRT (CRRT) for critically ill patients was introduced in 1977 and hailed almost immediately as an improved alternative to intermittent HD (IHD).…”

Role of Body Mass Index in Acute Kidney Injury Patients after Cardiac Surgery

“…AKI after cardiac surgery (CS-AKI) patients have higher mortality rates than those who did not develop AKI [4,5], and the mortality rate of AKI-renal replacement therapy (AKI-RRT) patients has been reported to be 41.4-65% [6,7,8,9]. Current research has found that there are many factors related to the incidence of CS-AKI and its outcome, with body mass index (BMI) being one of these risk factors.…”

Precision Fluid Management in Continuous Renal Replacement Therapy

“…CRRT parameters should be adjusted on a dynamic basis to achieve goals of organ support and should be guided by parameters of patients' end organ dysfunction. It should be stressed that frequent reassessment of these goals is critical and one of the advantages of CRRT is that this single therapy can be tailored to meet rapidly changing clinical needs [21] .…”