When to start a renal replacement therapy in acute kidney injury (AKI) patients: many irons in the fire

Romagnoli, Stefano; Ricci, Zaccaria

doi:10.21037/atm.2016.08.55

Cited by 11 publications

(6 citation statements)

References 7 publications

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“…Basis of definitions in published studies include urine output, creatinine, urea, time from AKI development and hospital or ICU admission (26,27). In addition, the terms "early" and "late" are relative and what may represent early CRRT in one case could be late in another (28). In our study, we defined "early" and "late" based on urine output, which were defined as "early" when UO during the 24 h prior to CRRT was >0.05 mL/kg/h and as "late" when UO was <0.05 mL/kg/h (11).…”

Section: Discussionmentioning

confidence: 99%

Optimal timing of initiating CRRT in patients with acute kidney injury after liver transplantation

Ren

Zhang

et al. 2020

Ann Transl Med

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Background: Acute kidney injury (AKI) is a frequent complication after liver transplantation (LT), and is associated with high mortality. Continuous renal replacement therapy (CRRT) is an important treatment for AKI, but the optimal time for initiation is still controversial. The purpose of this study was to investigate the prognostic effect of initial CRRT treatment time.Methods: We retrospectively reviewed the clinical data of 173 recipients undergoing LT from January 2018 to March 2019. AKI was defined according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. All patients receiving CRRT were divided into early and late group according to urine output. Prognosis was compared between the two groups.Results: A total of 48 (27.8%) patients were identified with AKI, 23 (13.3%) of whom received CRRT.According to urine output, 13 (56.5%) patients were in early group and 10 (43.5%) patients in late group. AKI was associated with longer intensive care unit (ICU) and hospital stay, increased post-operative 90-day mortality and the incidence of early allograft dysfunction (EAD). Patients in late CRRT group had a longer ICU stay {median, IQR, hours, P=0.043} and hospital stay {median, IQR, days, P=0.019} than patients in early CRRT group, respectively. The rate of severe infection was significantly higher in the late CRRT group than in the early CRRT group (80.0% vs. 30.8%, P=0.026).Conclusions: AKI was associated with longer length of ICU and hospital stay, poor short-term mortality and functional recovery of transplanted organ. Early initiation of CRRT could reduce the severe infection and length of ICU and hospital stay.

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Section: Discussionmentioning

confidence: 99%

Optimal timing of initiating CRRT in patients with acute kidney injury after liver transplantation

Ren

Zhang

et al. 2020

Ann Transl Med

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“…Additionally, another important aspect to consider is the vast heterogeneity of patients and RRT procedures among the RCTs, which may vary from sepsis, postoperative, leptospirosis, mixed populations and continuous renal replacement therapies (CRRT) or intermittent hemodialysis (IHD), with different doses and ultrafiltration rates, making the interpretation of results even more challenging. ( 19 - 23 ) Recently, two new RCTs evaluating the RRT timing in AKI patients were published, with important differences in the results. ( 6 , 7 ) While the 'Early versus LAte Initiation of renal replacement therapy in critically ill patients with acute kidNey injury' (ELAIN) trial randomized a majority of surgical patients undergoing CRRT to early versus delayed RRT initiation, ( 6 ) the 'Artificial Kidney Initiation in Kidney Injury' (AKIKI) trial randomized a mixed population with a large percentage of patients with sepsis and used IHD in the majority of the cases, ( 7 ) making it difficult to compare the results between these two investigations.…”

Section: Discussionmentioning

confidence: 99%

Early versus delayed initiation of renal replacement therapy for acute kidney injury: an updated systematic review, meta-analysis, meta-regression and trial sequential analysis of randomized controlled trials

Moreira¹,

Palomba²,

Chaves³

et al. 2018

Revista Brasileira De Terapia Intensiva

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ObjectiveTo evaluate whether early initiation of renal replacement therapy is associated with lower mortality in patients with acute kidney injury compared to delayed initiation.MethodsWe performed a systematic review and meta-analysis of randomized controlled trials comparing early versus delayed initiation of renal replacement therapy in patients with acute kidney injury without the life-threatening acute kidney injury-related symptoms of fluid overload or metabolic disorders. Two investigators extracted the data from the selected studies. The Cochrane Risk of Bias Tool was used to assess the quality of the studies, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to test the overall quality of the evidence.ResultsSix randomized controlled trials (1,292 patients) were included. There was no statistically significant difference between early and delayed initiation of renal replacement therapy regarding the primary outcome (OR 0.82; 95%CI, 0.48 - 1.42; p = 0.488), but there was an increased risk of catheter-related bloodstream infection when renal replacement therapy was initiated early (OR 1.77; 95%CI, 1.01 - 3.11; p = 0.047). The quality of evidence generated by our meta-analysis for the primary outcome was considered low due to the risk of bias of the included studies and the heterogeneity among them.ConclusionEarly initiation of renal replacement therapy is not associated with improved survival. However, the quality of the current evidence is low, and the criteria used for -early- and -delayed- initiation of renal replacement therapy are too heterogeneous among studies.

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“…Around 50% of undocumented immigrants with kidney failure in the United States are not eligible to access standard thrice-weekly haemodialysis under Medicare, Medicaid or the Patient Protection and Affordable Care Act, and only receive treatment ("emergency only haemodialysis") after they are assessed in the emergency department and found to have life threatening kidney failure. [13][14][15] Emergency only hemodialysis [27][28][29] (EOHD) is expensive and physically demanding.…”

Section: Examples Of Qualitative Studies That Have Changed Practice and Policy In Ckdmentioning

confidence: 99%

“…Commencement of care can be subjective, evolving dynamically, with the factors affecting the decisions varying between patients and health professionals. [13][14][15] The decision to initiate dialysis is a complex one that needs consideration of not only the biomarkers and physical symptoms of the disease (like biochemistry, fluid overload and estimated glomerular filtration rate) but also patient preferences for treatment and outcomes 15,16 .…”

Section: Examples Of Qualitative Studies That Have Changed Practice A...mentioning

confidence: 99%

“…The success of the treatments for kidney failure, including dialysis, depends to a great extent on the time when the treatment is initiated and the patient's adherence to different aspects of their treatment (e.g., diet, treatment regimens and fluid restrictions). Commencement of care can be subjective, evolving dynamically, with the factors affecting the decisions varying between patients and health professionals 13–15 . The decision to initiate dialysis is a complex one that needs consideration of not only the biomarkers and physical symptoms of the disease (like biochemistry, fluid overload and estimated glomerular filtration rate) but also patient preferences for treatment and outcomes 15,16 .…”

Section: Examples Of Qualitative Studies That Have Changed Practice A...mentioning

confidence: 99%

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Qualitative research methods and its application in nephrology

et al. 2021

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Chronic kidney disease is associated with an increased risk of mortality, comorbidities and life-threatening complications. Invasive treatments including dialysis or transplantation, complex pharmacological therapies, dietary restrictions and the ongoing need to attend follow-up appointments can place a substantial treatment burden on patients and carers and impair quality of life. This highlights the need for care that is responsive to the needs of patients and involves them in decision-making to achieve the most appropriate healthcare outcomes. Shared decision-making and collaborative approaches to care require a deep awareness of the lived experiences and goals of patients. Qualitative research methods can provide insights into patients' experiences, values and priorities and inform practice and policy by uncovering their preferences for care. Qualitative methods are increasingly being used in standalone projects or in mixed methods studies (complementing quantitative studies) to make valuable contributions to patient-centred research. Patient-centred care, collaborations between patient and care provider, and shared decision-making that integrates with the patient's goals are central to quality healthcare. The efficacy of qualitative research lies in its ability to elicit patients' perspectives, values, priorities and goals that underpin shared decision making and care. This article discusses examples of how qualitative research has informed practice and policy in nephrology, provides a summary of qualitative research methods and outlines a guide on how to appraise, interpret and apply qualitative data.

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When to start a renal replacement therapy in acute kidney injury (AKI) patients: many irons in the fire

Cited by 11 publications

References 7 publications

Optimal timing of initiating CRRT in patients with acute kidney injury after liver transplantation

Optimal timing of initiating CRRT in patients with acute kidney injury after liver transplantation

Early versus delayed initiation of renal replacement therapy for acute kidney injury: an updated systematic review, meta-analysis, meta-regression and trial sequential analysis of randomized controlled trials

Qualitative research methods and its application in nephrology

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