Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury

Bagshaw, Sean M.; Uchino, Shigehiko; Bellomo, Rinaldo; Morimatsu, Hiroshi; Morgera, Stanislao; Schetz, Miet; Tan, It-Koon; Bouman, Catherine S. C.; Macedo, Ettiene; Gibney, R. T. Noel; Tolwani, Ashita J.; Straaten, Heleen M. Oudemans–van; Ronco, Claudio; Kellum, John A.

doi:10.1016/j.jcrc.2007.12.017

Cited by 290 publications

(214 citation statements)

References 41 publications

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“…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]. The mortality was significantly lower in patients undergoing late (SCr level [3.49 mg/dL) RRT than early (SCr level B3.49 mg/dL) RRT, but late RRT was also associated with a longer duration of RRT.…”

Section: Level Of Evidence: I Grade Of Recommendation: B Rationale Cqsupporting

confidence: 85%

“…In summary, there is no evidence demonstrating the efficacy of RRT in patients with non-oliguric CIN. However, early RRT may decrease mortality and the incidence of major complications including kidney dysfunction in critically ill patients with oliguric CIN [192,194]. The vital prognosis is poor for CKD patients who developed CIN.…”

Section: Level Of Evidence: I Grade Of Recommendation: B Rationale Cqmentioning

confidence: 99%

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

et al. 2013

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Section: Level Of Evidence: I Grade Of Recommendation: B Rationale Cqsupporting

confidence: 85%

Section: Level Of Evidence: I Grade Of Recommendation: B Rationale Cqmentioning

confidence: 99%

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

et al. 2013

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“…[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.…”

Section: Discussionmentioning

confidence: 99%

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

Siddiqui

Coca

Devereaux

et al. 2012

CMAJ

118

116

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Research CMAJBackground: Acute kidney injury is a serious complication of elective major surgery. Acute dialysis is used to support life in the most severe cases. We examined whether rates and outcomes of acute dialysis after elective major surgery have changed over time. Methods:We used data from Ontario's universal health care databases to study all consecutive patients who had elective major surgery at 118 hospitals between 1995 and 2009. Our primary outcomes were acute dialysis within 14 days of surgery, death within 90 days of surgery and chronic dialysis for patients who did not recover kidney function.Results: A total of 552 672 patients underwent elective major surgery during the study period, 2231 of whom received acute dialysis. The incidence of acute dialysis increased steadily from 0.2% in 1995 (95% confidence interval [CI] 0.15-0.2) to 0.6% in 2009 (95% CI 0.6-0.7). This increase was primarily in cardiac and vascular surgeries. Among patients who received acute dialysis, 937 died within 90 days of surgery (42.0%, 95% CI 40.0-44.1), with no change in 90-day survival over time. Among the 1294 patients who received acute dialysis and survived beyond 90 days, 352 required chronic dialysis (27.2%, 95% CI 24.8-29.7), with no change over time.Interpretation: The use of acute dialysis after cardiac and vascular surgery has increased substantially since 1995. Studies focusing on interventions to better prevent and treat perioperative acute kidney injury are needed. Abstract

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“…However, when this same population was stratified along the median creatinine at initiation, those initiated at a higher creatinine had improved outcomes. Stratification by BUN had no effect (11).…”

mentioning

confidence: 87%

A Policy of Preemption

Wilson¹

2014

Clinical Journal of the American Society of Nephrology

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Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury

Cited by 290 publications

References 41 publications

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

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

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

A Policy of Preemption

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