TY - JOUR
T1 - Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury
AU - Bagshaw, Sean M.
AU - Uchino, Shigehiko
AU - Bellomo, Rinaldo
AU - Morimatsu, Hiroshi
AU - Morgera, Stanislao
AU - Schetz, Miet
AU - Tan, Ian
AU - Bouman, Catherine
AU - Macedo, Ettiene
AU - Gibney, Noel
AU - Tolwani, Ashita
AU - Oudemans-van Straaten, Heleen M.
AU - Ronco, Claudio
AU - Kellum, John A.
AU - AUTHOR GROUP
AU - French, Craig
AU - Mulder, John
AU - Pinder, Mary
AU - Roberts, Brigit
AU - Botha, John
AU - Mudholkar, Pradeen
AU - Holt, Andrew
AU - Hunt, Tamara
AU - Honoré, Patrick Maurice
AU - Clerbaux, Gaetan
AU - Schetz, Miet Maria
AU - Wilmer, Alexander
AU - Yu, Luis
AU - Macedo, Ettiene V.
AU - Laranja, Sandra Maria
AU - Rodrigues, Cassio José
AU - Suassuna, José Hermógenes Rocco
AU - Ruzany, Frederico
AU - Campos, Bruno
AU - Leblanc, Martine
AU - Senécal, Lynne
AU - Gibney, R. T. Noel
AU - Johnston, Curtis
AU - Brindley, Peter
AU - Tan, Ian K. S.
AU - Chen, Hui De
AU - Wan, Li
AU - Rokyta, Richard
AU - Krouzecky, Ales
AU - Neumayer, Hans-Helmut
AU - Detlef, Kindgen-Milles
AU - Mueller, Eckhard
AU - Tsiora, Vicky
AU - Sombolos, Kostas
AU - Mustafa, Iqbal
AU - de Pont, Anne-Cornelie J. M.
PY - 2009/3/1
Y1 - 2009/3/1
N2 - The aim of this study is to evaluate the relationship between timing of renal replacement therapy (RRT) in severe acute kidney injury and clinical outcomes. This was a prospective multicenter observational study conducted at 54 intensive care units (ICUs) in 23 countries enrolling 1238 patients. Timing of RRT was stratified into "early" and "late" by median urea and creatinine at the time RRT was started. Timing was also categorized temporally from ICU admission into early ( <2 days), delayed (2-5 days), and late (>5 days). Renal replacement therapy timing by serum urea showed no significant difference in crude (63.4% for urea 24.2 mmol/L; odds ratio [OR], 0.92; 95% confidence interval [CI], 0.73-1.15; P = .48) or covariate-adjusted mortality (OR, 1.25; 95% CI, 0.91-1.70; P = .16). When stratified by creatinine, late RRT was associated with lower crude (53.4% for creatinine >309 micromol/L vs 71.4% for creatinine <or=309 micromol/L; OR, 0.46; 95% CI, 0.36-0.58; P < .0001) and covariate-adjusted mortality (OR, 0.51; 95% CI, 0.37-0.69; P < .001). However, for timing relative to ICU admission, late RRT was associated with greater crude (72.8% vs 62.3% vs 59%, P < .001) and covariate-adjusted mortality (OR, 1.95; 95% CI, 1.30-2.92; P = .001). Overall, late RRT was associated with a longer duration of RRT and stay in hospital and greater dialysis dependence. Timing of RRT, a potentially modifiable factor, might exert an important influence on patient survival. However, this largely depended on its definition. Late RRT (days from admission) was associated with a longer duration of RRT, longer hospital stay, and higher dialysis dependence
AB - The aim of this study is to evaluate the relationship between timing of renal replacement therapy (RRT) in severe acute kidney injury and clinical outcomes. This was a prospective multicenter observational study conducted at 54 intensive care units (ICUs) in 23 countries enrolling 1238 patients. Timing of RRT was stratified into "early" and "late" by median urea and creatinine at the time RRT was started. Timing was also categorized temporally from ICU admission into early ( <2 days), delayed (2-5 days), and late (>5 days). Renal replacement therapy timing by serum urea showed no significant difference in crude (63.4% for urea 24.2 mmol/L; odds ratio [OR], 0.92; 95% confidence interval [CI], 0.73-1.15; P = .48) or covariate-adjusted mortality (OR, 1.25; 95% CI, 0.91-1.70; P = .16). When stratified by creatinine, late RRT was associated with lower crude (53.4% for creatinine >309 micromol/L vs 71.4% for creatinine <or=309 micromol/L; OR, 0.46; 95% CI, 0.36-0.58; P < .0001) and covariate-adjusted mortality (OR, 0.51; 95% CI, 0.37-0.69; P < .001). However, for timing relative to ICU admission, late RRT was associated with greater crude (72.8% vs 62.3% vs 59%, P < .001) and covariate-adjusted mortality (OR, 1.95; 95% CI, 1.30-2.92; P = .001). Overall, late RRT was associated with a longer duration of RRT and stay in hospital and greater dialysis dependence. Timing of RRT, a potentially modifiable factor, might exert an important influence on patient survival. However, this largely depended on its definition. Late RRT (days from admission) was associated with a longer duration of RRT, longer hospital stay, and higher dialysis dependence
KW - Acute kidney injury
KW - Acute renal failure
KW - Critical illness
KW - Delay
KW - Dialysis
KW - Hemofiltration
KW - Length of stay
KW - Mortality
KW - Renal recovery
KW - Renal replacement therapy
KW - Timing
UR - http://www.scopus.com/inward/record.url?scp=61449122315&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jcrc.2007.12.017
DO - https://doi.org/10.1016/j.jcrc.2007.12.017
M3 - Article
C2 - 19272549
SN - 0883-9441
VL - 24
SP - 129
EP - 140
JO - Journal of Critical Care
JF - Journal of Critical Care
IS - 1
ER -