Impact of timing of renal replacement therapy initiation on outcome of septic acute kidney injury

Yu Hsiang Chou; Tao Min Huang; Vin Cent Wu; Cheng Yi Wang; Chih Chung Shiao; Chun Fu Lai; Hung Bin Tsai; Chia Ter Chao; Guang Huar Young; Wei Jei Wang; Tze Wah Kao; Shuei Liong Lin; Yin Yi Han; Anne Chou; Tzu Hsin Lin; Ya Wen Yang; Yung Ming Chen; Pi Ru Tsai; Yu Feng Lin; Jenq Wen Huang; Wen Chih Chiang; Nai Kuan Chou; Wen Je Ko; Kwan Dun Wu; Tun Jun Tsai

doi:10.1186/cc10252

Impact of timing of renal replacement therapy initiation on outcome of septic acute kidney injury

Yu Hsiang Chou, Tao Min Huang, Vin Cent Wu, Cheng Yi Wang, Chih Chung Shiao, Chun Fu Lai, Hung Bin Tsai, Chia Ter Chao, Guang Huar Young, Wei Jei Wang, Tze Wah Kao, Shuei Liong Lin, Yin Yi Han, Anne Chou, Tzu Hsin Lin, Ya Wen Yang, Yung Ming Chen, Pi Ru Tsai, Yu Feng Lin, Jenq Wen HuangWen Chih Chiang, Nai Kuan Chou, Wen Je Ko^*, Kwan Dun Wu, Tun Jun Tsai

^*Corresponding author for this work

Research output: Contribution to journal › Journal Article › peer-review

94 Scopus citations

Abstract

Introduction: Sepsis is the leading cause of acute kidney injury (AKI) in critical patients. The optimal timing of initiating renal replacement therapy (RRT) in septic AKI patients remains controversial. The objective of this study is to determine the impact of early or late initiation of RRT, as defined using the simplified RIFLE (risk, injury, failure, loss of kidney function, and end-stage renal failure) classification (sRIFLE), on hospital mortality among septic AKI patients.Methods: Patient with sepsis and AKI requiring RRT in surgical intensive care units were enrolled between January 2002 and October 2009. The patients were divided into early (sRIFLE-0 or -Risk) or late (sRIFLE-Injury or -Failure) initiation of RRT by sRIFLE criteria. Cox proportional hazard ratios for in hospital mortality were determined to assess the impact of timing of RRT.Results: Among the 370 patients, 192 (51.9%) underwent early RRT and 259 (70.0%) died during hospitalization. The mortality rate in early and late RRT groups were 70.8% and 69.7% respectively (P > 0.05). Early dialysis did not relate to hospital mortality by Cox proportional hazard model (P > 0.05). Patients with heart failure, male gender, higher admission creatinine, and operation were more likely to be in the late RRT group. Cox proportional hazard model, after adjustment with propensity score including all patients based on the probability of late RRT, showed early dialysis was not related to hospital mortality. Further model matched patients by 1:1 fashion according to each patient's propensity to late RRT showed no differences in hospital mortality according to head-to-head comparison of demographic data (P > 0.05).Conclusions: Use of sRIFLE classification as a marker poorly predicted the benefits of early or late RRT in the context of septic AKI. In the future, more physiologically meaningful markers with which to determine the optimal timing of RRT initiation should be identified.

Original language	English
Article number	R134
Journal	Critical Care
Volume	15
Issue number	3
DOIs	https://doi.org/10.1186/cc10252
State	Published - 06 06 2011
Externally published	Yes

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Chou, Y. H., Huang, T. M., Wu, V. C., Wang, C. Y., Shiao, C. C., Lai, C. F., Tsai, H. B., Chao, C. T., Young, G. H., Wang, W. J., Kao, T. W., Lin, S. L., Han, Y. Y., Chou, A., Lin, T. H., Yang, Y. W., Chen, Y. M., Tsai, P. R., Lin, Y. F., ... Tsai, T. J. (2011). Impact of timing of renal replacement therapy initiation on outcome of septic acute kidney injury. Critical Care, 15(3), Article R134. https://doi.org/10.1186/cc10252

@article{032b1db8240f4666b3b962c28c577bbb,

title = "Impact of timing of renal replacement therapy initiation on outcome of septic acute kidney injury",

abstract = "Introduction: Sepsis is the leading cause of acute kidney injury (AKI) in critical patients. The optimal timing of initiating renal replacement therapy (RRT) in septic AKI patients remains controversial. The objective of this study is to determine the impact of early or late initiation of RRT, as defined using the simplified RIFLE (risk, injury, failure, loss of kidney function, and end-stage renal failure) classification (sRIFLE), on hospital mortality among septic AKI patients.Methods: Patient with sepsis and AKI requiring RRT in surgical intensive care units were enrolled between January 2002 and October 2009. The patients were divided into early (sRIFLE-0 or -Risk) or late (sRIFLE-Injury or -Failure) initiation of RRT by sRIFLE criteria. Cox proportional hazard ratios for in hospital mortality were determined to assess the impact of timing of RRT.Results: Among the 370 patients, 192 (51.9\%) underwent early RRT and 259 (70.0\%) died during hospitalization. The mortality rate in early and late RRT groups were 70.8\% and 69.7\% respectively (P > 0.05). Early dialysis did not relate to hospital mortality by Cox proportional hazard model (P > 0.05). Patients with heart failure, male gender, higher admission creatinine, and operation were more likely to be in the late RRT group. Cox proportional hazard model, after adjustment with propensity score including all patients based on the probability of late RRT, showed early dialysis was not related to hospital mortality. Further model matched patients by 1:1 fashion according to each patient's propensity to late RRT showed no differences in hospital mortality according to head-to-head comparison of demographic data (P > 0.05).Conclusions: Use of sRIFLE classification as a marker poorly predicted the benefits of early or late RRT in the context of septic AKI. In the future, more physiologically meaningful markers with which to determine the optimal timing of RRT initiation should be identified.",

author = "Chou, \{Yu Hsiang\} and Huang, \{Tao Min\} and Wu, \{Vin Cent\} and Wang, \{Cheng Yi\} and Shiao, \{Chih Chung\} and Lai, \{Chun Fu\} and Tsai, \{Hung Bin\} and Chao, \{Chia Ter\} and Young, \{Guang Huar\} and Wang, \{Wei Jei\} and Kao, \{Tze Wah\} and Lin, \{Shuei Liong\} and Han, \{Yin Yi\} and Anne Chou and Lin, \{Tzu Hsin\} and Yang, \{Ya Wen\} and Chen, \{Yung Ming\} and Tsai, \{Pi Ru\} and Lin, \{Yu Feng\} and Huang, \{Jenq Wen\} and Chiang, \{Wen Chih\} and Chou, \{Nai Kuan\} and Ko, \{Wen Je\} and Wu, \{Kwan Dun\} and Tsai, \{Tun Jun\}",

year = "2011",

month = jun,

day = "6",

doi = "10.1186/cc10252",

language = "英语",

volume = "15",

journal = "Critical Care",

issn = "1364-8535",

publisher = "BioMed Central Ltd",

number = "3",

}

Chou, YH, Huang, TM, Wu, VC, Wang, CY, Shiao, CC, Lai, CF, Tsai, HB, Chao, CT, Young, GH, Wang, WJ, Kao, TW, Lin, SL, Han, YY, Chou, A, Lin, TH, Yang, YW, Chen, YM, Tsai, PR, Lin, YF, Huang, JW, Chiang, WC, Chou, NK, Ko, WJ, Wu, KD & Tsai, TJ 2011, 'Impact of timing of renal replacement therapy initiation on outcome of septic acute kidney injury', Critical Care, vol. 15, no. 3, R134. https://doi.org/10.1186/cc10252

TY - JOUR

T1 - Impact of timing of renal replacement therapy initiation on outcome of septic acute kidney injury

AU - Chou, Yu Hsiang

AU - Huang, Tao Min

AU - Wu, Vin Cent

AU - Wang, Cheng Yi

AU - Shiao, Chih Chung

AU - Lai, Chun Fu

AU - Tsai, Hung Bin

AU - Chao, Chia Ter

AU - Young, Guang Huar

AU - Wang, Wei Jei

AU - Kao, Tze Wah

AU - Lin, Shuei Liong

AU - Han, Yin Yi

AU - Chou, Anne

AU - Lin, Tzu Hsin

AU - Yang, Ya Wen

AU - Chen, Yung Ming

AU - Tsai, Pi Ru

AU - Lin, Yu Feng

AU - Huang, Jenq Wen

AU - Chiang, Wen Chih

AU - Chou, Nai Kuan

AU - Ko, Wen Je

AU - Wu, Kwan Dun

AU - Tsai, Tun Jun

PY - 2011/6/6

Y1 - 2011/6/6

N2 - Introduction: Sepsis is the leading cause of acute kidney injury (AKI) in critical patients. The optimal timing of initiating renal replacement therapy (RRT) in septic AKI patients remains controversial. The objective of this study is to determine the impact of early or late initiation of RRT, as defined using the simplified RIFLE (risk, injury, failure, loss of kidney function, and end-stage renal failure) classification (sRIFLE), on hospital mortality among septic AKI patients.Methods: Patient with sepsis and AKI requiring RRT in surgical intensive care units were enrolled between January 2002 and October 2009. The patients were divided into early (sRIFLE-0 or -Risk) or late (sRIFLE-Injury or -Failure) initiation of RRT by sRIFLE criteria. Cox proportional hazard ratios for in hospital mortality were determined to assess the impact of timing of RRT.Results: Among the 370 patients, 192 (51.9%) underwent early RRT and 259 (70.0%) died during hospitalization. The mortality rate in early and late RRT groups were 70.8% and 69.7% respectively (P > 0.05). Early dialysis did not relate to hospital mortality by Cox proportional hazard model (P > 0.05). Patients with heart failure, male gender, higher admission creatinine, and operation were more likely to be in the late RRT group. Cox proportional hazard model, after adjustment with propensity score including all patients based on the probability of late RRT, showed early dialysis was not related to hospital mortality. Further model matched patients by 1:1 fashion according to each patient's propensity to late RRT showed no differences in hospital mortality according to head-to-head comparison of demographic data (P > 0.05).Conclusions: Use of sRIFLE classification as a marker poorly predicted the benefits of early or late RRT in the context of septic AKI. In the future, more physiologically meaningful markers with which to determine the optimal timing of RRT initiation should be identified.

AB - Introduction: Sepsis is the leading cause of acute kidney injury (AKI) in critical patients. The optimal timing of initiating renal replacement therapy (RRT) in septic AKI patients remains controversial. The objective of this study is to determine the impact of early or late initiation of RRT, as defined using the simplified RIFLE (risk, injury, failure, loss of kidney function, and end-stage renal failure) classification (sRIFLE), on hospital mortality among septic AKI patients.Methods: Patient with sepsis and AKI requiring RRT in surgical intensive care units were enrolled between January 2002 and October 2009. The patients were divided into early (sRIFLE-0 or -Risk) or late (sRIFLE-Injury or -Failure) initiation of RRT by sRIFLE criteria. Cox proportional hazard ratios for in hospital mortality were determined to assess the impact of timing of RRT.Results: Among the 370 patients, 192 (51.9%) underwent early RRT and 259 (70.0%) died during hospitalization. The mortality rate in early and late RRT groups were 70.8% and 69.7% respectively (P > 0.05). Early dialysis did not relate to hospital mortality by Cox proportional hazard model (P > 0.05). Patients with heart failure, male gender, higher admission creatinine, and operation were more likely to be in the late RRT group. Cox proportional hazard model, after adjustment with propensity score including all patients based on the probability of late RRT, showed early dialysis was not related to hospital mortality. Further model matched patients by 1:1 fashion according to each patient's propensity to late RRT showed no differences in hospital mortality according to head-to-head comparison of demographic data (P > 0.05).Conclusions: Use of sRIFLE classification as a marker poorly predicted the benefits of early or late RRT in the context of septic AKI. In the future, more physiologically meaningful markers with which to determine the optimal timing of RRT initiation should be identified.

UR - https://www.scopus.com/pages/publications/79957888137

U2 - 10.1186/cc10252

DO - 10.1186/cc10252

M3 - 文章

C2 - 21645350

AN - SCOPUS:79957888137

SN - 1364-8535

VL - 15

JO - Critical Care

JF - Critical Care

IS - 3

M1 - R134

ER -

Impact of timing of renal replacement therapy initiation on outcome of septic acute kidney injury

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