Timing of Replacement Therapy for Acute Renal Failure After Cardiac Surgery

Demirkılıç, Ufuk; Kuralay, Erkan; Yenicesu, Müjdat; Çağlar, Kayser; Oz, Bilgehan Savas; Cingoz, Faruk; Günay, Celalettin; Yıldırım, Vedat; Ceylan, Süleyman; Arslan, Mehmet; Vural, Abdülgaffar; Tatar, Harun

doi:10.1111/j.0886-0440.2004.04004.x

Cited by 191 publications

(104 citation statements)

References 16 publications

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“…In this study, the door-to-dialysis time was significantly shorter in the PaDD group than in the DAdD group. Studies have shown that door-to-dialysis time is associated with the degree of azotemia and with mortality (11,12,20). Hemodynamic stability was maintained during SLED treatments in both groups.…”

Section: Discussionmentioning

confidence: 89%

Door-to-Dialysis Time and Daily Hemodialysis in Patients with Leptospirosis

Andrade

Cleto

Seguro

2007

Clinical Journal of the American Society of Nephrology

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Background: Leptospirosis is a public health problem, the severe form of which (Weil's disease) includes acute respiratory distress syndrome, typically accompanied by acute kidney injury (AKI), and is associated with high mortality rates. Recent evidence suggests that dialysis dosage affects outcomes in critically ill patients with sepsis-induced AKI. However, this population varies widely in terms of age, gender, and concomitant conditions, making it difficult to determine the appropriate timing (door-to-dialysis time) and dialysis dosage.Design, setting, participants, and measurements: It is logical to assume that increasing the dialysis dosage would minimize uremic complications and improve outcomes in such patients. Patients with Weil's disease constitute a homogeneous population and are typically free of comorbidities, therefore presenting an ideal model in which to test this assumption.Results Conclusions: On the basis of this result, it is believed that alternate-day hemodialysis is no longer appropriate for critically ill patients with Weil's disease.

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Section: Discussionmentioning

confidence: 89%

Door-to-Dialysis Time and Daily Hemodialysis in Patients with Leptospirosis

Andrade

Cleto

Seguro

2007

Clinical Journal of the American Society of Nephrology

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“…Whether early dialysis can improve the uremic milieu of AKI and improve outcomes is unknown. Although a number of studies suggest that early initiation of dialysis may improve mortality in patients with AKI, [36][37][38][39] this remains an area of uncertainty and controversy.…”

Section: Discussionmentioning

confidence: 99%

In Critically Ill Patients Requiring CRRT, AKI Is Associated with Increased Respiratory Failure and Death Versus ESRD

et al. 2011

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Background/aims: To compare outcomes of critically ill patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) versus those with pre-existing end-stage renal disease (ESRD) requiring CRRT to identify factors that contribute to the increased mortality seen in AKI patients. Methods: Retrospective cohort of 257 intensive care unit (ICU) patients who received CRRT. AKI is defined as requiring CRRT with an admission serum creatinine ≤1 mg/dL; ESRD is defined as chronic dialysis dependence. Primary outcome was hospital mortality. Multivariate logistic regression was performed to determine the impact of APACHE II score, intubation, vasopressors, infection, diabetes, hypertension, gender, and race on mortality. Results: Of 257 patients requiring CRRT, 28 had ESRD and 108 had AKI. Hospital mortality was higher in patients with AKI versus ESRD (69% vs. 39%, p = 0.0032). Severity of illness using APACHE II was similar in AKI and ESRD. Patients with AKI were more likely to require mechanical ventilation (89% vs. 57%, p = 0.0003). After multivariate analysis, the requirement for mechanical ventilation was the single factor associated with increased hospital mortality [odds ratio (OR): 3.1]. Conclusions: In ICU patients requiring CRRT, patients with AKI have a higher mortality than patients with ESRD due to an increased need for mechanical ventilation.

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“…It must also be clearly stated that the traditional indications for timing of RRT in relatively stable patients with isolated acute oliguric renal failure as a single organ system failure not be applied to critically ill patients with AKI as a component of multiple organ failure. In addition, there is a growing body of evidence that fluid overload as a result of AKI contributes significantly to mortality and morbidity and that control of volume status with continuous renal replacement therapy (CRRT) can improve outcomes, especially in pediatric AKI and following cardiac surgery (11)(12)(13)(14)(15). A pH cutoff of 7.15 was chosen in parallel to the Surviving Sepsis Campaign guidelines (16).…”

Section: Parametersmentioning

confidence: 99%

“…There is no consensus on the exact indications for RRT in terms of BUN levels or RIFLE/ AKI staging, although there has been a trend in clinical practice toward earlier RRT in the critically ill. Indeed, a small number of studies suggest that earlier initiation is associated with improved AKI outcome in critically ill patients (14,15,19,20).…”

Section: Current Levels Of Evidence For Use Of Rrt In Akimentioning

confidence: 99%

“…Two single-center retrospective studies in patients with AKI following cardiac surgery showed improved survival and shorter hospital stay with earlier initiation of CRRT (14,15). An additional 2 retrospective observational studies have also shown improved outcomes with earlier initiation of RRT (19,20) One of these, a retrospective, cohort study, used a BUN level greater than or less than 60 mg/dl (21.4 mmol/L) as a surrogate of "timing of intervention" (19).…”

Section: Current Levels Of Evidence For Use Of Rrt In Akimentioning

confidence: 99%

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