Who may not benefit from continuous renal replacement therapy in acute kidney injury?

Abstract

This study aimed to identify factors that may predict early kidney recovery (less than 48 hours) or early death (within 48 hours) after initiating continuous renal replacement therapy (CRRT) in acute kidney injury (AKI) patients. This is a multicenter retrospective observational study of 14 Japanese Intensive care units (ICUs) in 12 tertiary hospitals. Consecutive adult patients with severe AKI requiring CRRT admitted to the participating ICUs in 2010 (n=343) were included. Patient characteristics, variables at CRRT initiation, settings, and outcomes were collected. Patients were grouped into early kidney recovery group (CRRT discontinuation within 48 hours after initiation, n=52), early death group (death within 48 hours after CRRT initiation, n=52), and the rest as the control group (n=239). The mean duration of CRRT in the early kidney recovery group and early death group was 1.3 and 0.9 days, respectively. In multivariable regression analysis, in comparison with the control group, urine output (mL/h) (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01-1.03), duration between ICU admission to CRRT initiation (days) (OR: 0.65, 95% CI: 0.43-0.87), and the sepsis-related organ failure assessment score (OR: 0.87, 95% CI; 0.78-0.96) were related to early kidney recovery. Serum lactate (mmol/L) (OR: 1.19, 95% CI: 1.11-1.28), albumin (g/dL) (OR: 0.52, 95% CI: 0.28-0.92), vasopressor use (OR: 3.68, 95% CI: 1.37-12.16), and neurological disease (OR: 9.64, 96% CI: 1.22-92.95) were related to early death. Identifying AKI patients who do not benefit from CRRT and differentiating such patients from the study cohort may allow previous and future studies to effectively evaluate the indication and role of CRRT.

Renal replacement therapy for acute kidney injury

“…Kawarazaki et al examined the predictive factors of early kidney recovery (within 48 h) after CRRT initiation in AKI patients in a multicenter retrospective observational study of 14 Japanese ICUs. In multivariable regression analysis, urine output (mL/h), duration between ICU admission and CRRT initiation (days), and the SOFA score were related to early kidney recovery (OR 1.02, 0.65, 0.87; 95 % confidence interval [13].…”

The Japanese Clinical Practice Guideline for acute kidney injury 2016

“…Our literature search found three observational studies that identified predictors of the possibility to wean patients from blood purification to date. [226]. The comparison of an early recovery group (those who could discontinue CRRT within 48 h of initiation; n = 52) and a control group that excepted patients who died early (n = 239) revealed that the urine output upon CRRT initiation (mL/h) (OR 1.02, 95% CI 1.01-1.03), the SOFA score upon CRRT initiation (OR 0.87, 95% CI 0.78-0.96), and the time from ICU admission to CRRT initiation (in days) (OR 0.65, 95% CI 0.43-0.87) were significantly associated with early weaning from CRRT.…”

Life after Acute Kidney Injury

“…Kawarazaki et al stellten in ihrer retrospektiven japanischen Kohorte aus 12 Zentren eine Assoziation von neurologischen Erkrankungen mit einem frühen Tod nach Nierenersatztherapie bei ANV (6 % vs. 1 %; OR 9,64; 95%-KI: 1,22-92,95; p = 0,03) als unabhängigen Risikofaktor fest, wobei die geringe Anzahl von Patienten eine Interpretation der Daten erschwert (n = 2 Kontrollgruppe, n = 3 in der Early-deathGruppe; [35]). …”