Timing of Initiation and Discontinuation of Renal Replacement Therapy in AKI

Gibney, R. T. Noel; Hoste, Eric; Burdmann, Emmanuel A.; Bunchman, Timothy E.; Kher, Vijay; Viswanathan, Ravindran; Mehta, Ravindra L.; Ronco, Claudio

doi:10.2215/cjn.04871107

Cited by 133 publications

(109 citation statements)

References 29 publications

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“…35 Illness severity and organ failure were characterized by the Acute Physiology and Chronic Health Evaluation (APACHE) II score 36 and the Sequential Organ Failure Assessment (SOFA) score. 37,38 Based on a consensus statement by the AKIN, 39 we defined several objectively measured 'traditional' indications for RRT initiation: serum urea [ 35.7 mmolÁL -1 ; serum potassium [ 6 mmolÁL…”

Section: Study Definitionsmentioning

confidence: 99%

Timing the initiation of renal replacement therapy for acute kidney injury in Canadian intensive care units: a multicentre observational study

Clark

Wald

Levin

et al. 2012

Can J Anesth/J Can Anesth

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Section: Study Definitionsmentioning

confidence: 99%

Timing the initiation of renal replacement therapy for acute kidney injury in Canadian intensive care units: a multicentre observational study

Clark

Wald

Levin

et al. 2012

Can J Anesth/J Can Anesth

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“…Criteria for initiation of RRT for AKI included volume overload and oliguria, acidosis, hyperkalemia, uremic symptoms, or uremia [32].…”

Section: Processes Of Carementioning

confidence: 99%

Epidemiology of contrast-associated acute kidney injury in ICU patients: a retrospective cohort analysis

et al. 2011

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Intensive care unit (ICU) patients frequently undergo contrast-enhanced radiographic examinations, which carries a risk for development of contrast-associated acute kidney injury (CA-AKI). Data on this in ICU patients are scarce. The aim of this study was therefore to evaluate the epidemiology and short- and long-term outcomes of CA-AKI in ICU patients. A retrospective single-centre cohort study covering the period 1 March 2004 to 31 December 2008 on ICU patients who underwent a radiography examination with parenteral administration of iodinated radio contrast media was conducted. Data analysis included univariate and multivariate analyses of patients with and without CA-AKI. A total of 787 ICU patients were included in the study. CA-AKI occurred in 128 (16.3%) and was associated with higher need for RRT [30 (4.6%) vs. 21 (16.4%), p < 0.001], worse kidney function at discharge, longer length of ICU and hospital stay, and higher 28-day and 1-year mortality [28-day: 86 (13.1%) vs. 46 (35.9%), p < 0.001, and 1-year: 158 (24.0%) vs. 71 (55.5%), p < 0.001]. Higher serum creatinine, lower mean arterial pressure, and administration of diuretics and vasoactive therapy were associated with development of CA-AKI in multivariate analysis. After correction for confounders we found that CA-AKI was associated with 28-day mortality in this cohort of ICU patients (odds ratio = 2.742, 95% confidence interval 1.374-5.471). CA-AKI occurred in one out of six ICU patients who underwent a contrast-enhanced radiography examination and was associated with both short-and long-term worse outcomes such as need for RRT, worse kidney function at discharge, increased length of stay in the ICU and hospital, and mortality

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“…These indications include severe metabolic acidosis, refractory hyperkalemia, and fluid overload with pulmonary edema unresponsive to other forms of treatment (1,8,9). Additionally, sustained oliguria/anuria and complications of uremia are considered to be conventional indications (1,8).…”

Section: Introductionmentioning

confidence: 99%

Timing of RRT Based on the Presence of Conventional Indications

Vaara

Reinikainen

Wald

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives No data on the development of conventional indications for RRT (refractory acidosis, hyperkalemia, uremia, oliguria/anuria, and volume overload) related to timing of RRT exist. The prevalence of conventional indications among critically ill patients on RRT for AKI was evaluated, and patients manifesting indications versus patients without indications were compared in terms of crude and adjusted 90-day mortality.Design, setting, participants, & measurements In this substudy of the Finnish Acute Kidney Injury study conducted in 2011 and 2012 in 17 intensive care units with 2901 patients, patients were classified as pre-emptive (no conventional indications) and classic (one or more indications) RRT recipients. Patients with classic RRT were divided into classic-urgent (RRT initiated #12 hours from manifesting indications) and classic-delayed (RRT .12 hours from first indication). Additionally, 2450 patients treated without RRT were matched to patients with preemptive RRT.Results Of 239 patients treated with RRT, 134 (56.1%; 95% confidence interval [95% CI], 49.8% to 62.4%) fulfilled at least one conventional indication before commencing RRT. Crude 90-day mortality of 134 patients with classic RRT was 48.5% (95% CI, 40.0% to 57.0%), and it was 29.5% (95% CI, 20.8% to 38.2%) for the 105 patients with preemptive RRT. Classic RRT was associated with a higher risk for mortality (adjusted odds ratio, 2.05; 95% CI, 1.03 to 4.09). Forty-four patients with classic-delayed RRT showed higher crude mortality (68.2%; 95% CI, 54.4% to 82.0%) compared with patients with classic-urgent RRT, and this association persisted after adjustment for known confounders (odds ratio, 3.85; 95% CI, 1.48 to 10.22). Crude 90-day mortality of 67 1:1 matched patients with pre-emptive RRT was 26.9% (95% CI, 6.3% to 37.5%), and it was 49.3% (95% CI, 37.3% to 61.2%; P=0.01) for their non-RRT matches.Conclusions Patients on RRT after one or more conventional indications had both higher crude and adjusted 90-day mortality compared with patients without conventional indications. These findings require confirmation in an adequately powered, multicenter, randomized controlled trial.

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Timing of Initiation and Discontinuation of Renal Replacement Therapy in AKI

Abstract: Patients with acute kidney injury (AKI) often require initiation of renal replacement therapy (RRT).

Cited by 133 publications

References 29 publications

Timing the initiation of renal replacement therapy for acute kidney injury in Canadian intensive care units: a multicentre observational study

Timing the initiation of renal replacement therapy for acute kidney injury in Canadian intensive care units: a multicentre observational study

Epidemiology of contrast-associated acute kidney injury in ICU patients: a retrospective cohort analysis

Timing of RRT Based on the Presence of Conventional Indications

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