Elhawy, A., Sadaka, M., Hasan, F., Abdul Hamed, H., Elsayed, M. (2018). Timing of Renal Replacement Therapy and its impact on the Outcome of Acute Kidney Injury Patients. The Egyptian Journal of Hospital Medicine, 72(7), 4956-4963. doi: 10.21608/ejhm.2018.10180
Ahmed Mohammed Owais Elhawy; Mohammed Zaher Sadaka; Fawzy Hamed Hasan; Haytham Sabry Abdul Hamed; Mohamed Ahmed Elsayed. "Timing of Renal Replacement Therapy and its impact on the Outcome of Acute Kidney Injury Patients". The Egyptian Journal of Hospital Medicine, 72, 7, 2018, 4956-4963. doi: 10.21608/ejhm.2018.10180
Elhawy, A., Sadaka, M., Hasan, F., Abdul Hamed, H., Elsayed, M. (2018). 'Timing of Renal Replacement Therapy and its impact on the Outcome of Acute Kidney Injury Patients', The Egyptian Journal of Hospital Medicine, 72(7), pp. 4956-4963. doi: 10.21608/ejhm.2018.10180
Elhawy, A., Sadaka, M., Hasan, F., Abdul Hamed, H., Elsayed, M. Timing of Renal Replacement Therapy and its impact on the Outcome of Acute Kidney Injury Patients. The Egyptian Journal of Hospital Medicine, 2018; 72(7): 4956-4963. doi: 10.21608/ejhm.2018.10180
Timing of Renal Replacement Therapy and its impact on the Outcome of Acute Kidney Injury Patients
Department of Internal Medicine and Nephrology, Faculty of Medicine, Al-Azhar University
Abstract
Background: Previous studies using Acute Kidney Injury Network (AKIN)/RIFLE criteria to classify early initiation of renal replacement therapy (RRT) have defined it as the therapy started in less severe AKIN/RIFLE stages. Generally, these studies failed in demonstrating measurable benefits. Aim: To evaluate RRT in critically ill patients and its timing and its impact on critically ill patients. Methods: We compared RRT initiation in critically ill patients and defined early or late RRT in reference to timing after stage 3 AKIN was met: patients beginning RRT within 24 hours after acute kidney injury (AKI) stage 3 were considered early starters. AKIN criteria were evaluated by both urine output (UO) and serum creatinine (sCr) and patients with acute-on-chronic kidney disease were excluded. A propensity score methodology was used to control variables. Results: A total of 358 critically ill patients were submitted to RRT. Only 150 patients with pure AKI at stage 3 were analyzed. Mortality was lower in the early RRT group (51.5 vs. 77.9%, P = 0.001). After achieving balance between the groups using a propensity score, there was a significant 30.5 (95% confidence interval [CI] 14.4 to 45.2%, P = 0.002) relative decrease of mortality in the early RRT group. Moreover, patients on the early RRT group had lower duration of mechanical ventilation, time on RRT and a trend to lower intensive care unit (ICU) length of stay. Conclusions: For the first time, AKIN was used with UO criterion to evaluate early and late RRT. Using a time based approach could be a better parameter to access the association between RRT initiation and outcomes in patients with AKI.