Early initiation of renal replacement therapy improves survival in patients with acute kidney injury

Background/Aim. Defining renal replacement therapy (RRT) initiation in critically ill patients with acute kidney injury (AKI) has become an imperative for nephrologists and intensivists. The aim of this study was to determine 28-day survival and the renal function recovery in patients with AKI. Meth...

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Autores principales:	Knežević Violeta, Azaševac Tijana, Šibalić-Simin Marija, Sladojević Vesna, Urošević Ivana, Ćelić Dejan
Formato:	article
Lenguaje:	EN SR
Publicado:	Military Health Department, Ministry of Defance, Serbia 2021
Materias:	acute kidney injury renal dialysis mortality risk assessment survival time factors Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/bb7572ce722c4d87964538cedaa818e8
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spelling	oai:doaj.org-article:bb7572ce722c4d87964538cedaa818e82021-11-10T07:27:57ZEarly initiation of renal replacement therapy improves survival in patients with acute kidney injury0042-84502406-072010.2298/VSP191117019Khttps://doaj.org/article/bb7572ce722c4d87964538cedaa818e82021-01-01T00:00:00Zhttp://www.doiserbia.nb.rs/img/doi/0042-8450/2021/0042-84502000019K.pdfhttps://doaj.org/toc/0042-8450https://doaj.org/toc/2406-0720Background/Aim. Defining renal replacement therapy (RRT) initiation in critically ill patients with acute kidney injury (AKI) has become an imperative for nephrologists and intensivists. The aim of this study was to determine 28-day survival and the renal function recovery in patients with AKI. Methods. A single-center retrospective study included 385 surgical and non-surgical patients with AKI and episode of AKI in chronic kidney disease who were admitted to the Emergency Center of Clinical Center of Vojvodina (Novi Sad, Serbia) between 2014 and 2017 and received RRT. Patients with the Kidney Disease Improving Global Outcomes (KDIGO) stage 2 AKI and/or volume overload were assigned to the “early” group with RRT (dialysis) start within 24 h of the diagnosis; patients with poor response to conservative treatment or evidence of clinical complications associated with AKI were assigned to the “late” RRT group. Results. Based on the retrospective analysis we found that 241 patients (62.6%) received “early” RRT within 24 h. Patients in the “early” RRT group had significantly higher survival compared to the “late” RRT group (63.9% vs. 36.1%; p = 0.001). The “early” RRT group had more patients with renal function recovery (56.8%), but without statistical significance (p = 0.514). The patients who started RRT within 24 hours with the Sequential Organ Failure Assessment (SOFA) score of 1–3 were twice likely to recover renal function in relation to the patients with the SOFA score of 4 or higher [odds ratio (OR) = 2.01; 95% confidence interval (CI): 1.37–2.95; p < 0.001], while septic patients had a 62% lower chance of renal function recovery in relation to non-septic patients (OR = 0.38; 95% CI: 0.18–0.82; p = 0.013). In the “late” RRT group, it was found that non-diabetic patients had 3.8 times greater chance for renal function recovery compared to diabetic patients (OR = 3.53; 95% CI: 1.27–9.83; p = 0.016). Conclusions. Patients with the early initiation of RRT had significantly improved 28-day survival.Knežević VioletaAzaševac TijanaŠibalić-Simin MarijaSladojević VesnaUrošević IvanaĆelić DejanMilitary Health Department, Ministry of Defance, Serbiaarticleacute kidney injuryrenal dialysismortalityrisk assessmentsurvivaltime factorsMedicine (General)R5-920ENSRVojnosanitetski Pregled, Vol 78, Iss 10, Pp 1028-1035 (2021)
institution	DOAJ
collection	DOAJ
language	EN SR
topic	acute kidney injury renal dialysis mortality risk assessment survival time factors Medicine (General) R5-920
spellingShingle	acute kidney injury renal dialysis mortality risk assessment survival time factors Medicine (General) R5-920 Knežević Violeta Azaševac Tijana Šibalić-Simin Marija Sladojević Vesna Urošević Ivana Ćelić Dejan Early initiation of renal replacement therapy improves survival in patients with acute kidney injury
description	Background/Aim. Defining renal replacement therapy (RRT) initiation in critically ill patients with acute kidney injury (AKI) has become an imperative for nephrologists and intensivists. The aim of this study was to determine 28-day survival and the renal function recovery in patients with AKI. Methods. A single-center retrospective study included 385 surgical and non-surgical patients with AKI and episode of AKI in chronic kidney disease who were admitted to the Emergency Center of Clinical Center of Vojvodina (Novi Sad, Serbia) between 2014 and 2017 and received RRT. Patients with the Kidney Disease Improving Global Outcomes (KDIGO) stage 2 AKI and/or volume overload were assigned to the “early” group with RRT (dialysis) start within 24 h of the diagnosis; patients with poor response to conservative treatment or evidence of clinical complications associated with AKI were assigned to the “late” RRT group. Results. Based on the retrospective analysis we found that 241 patients (62.6%) received “early” RRT within 24 h. Patients in the “early” RRT group had significantly higher survival compared to the “late” RRT group (63.9% vs. 36.1%; p = 0.001). The “early” RRT group had more patients with renal function recovery (56.8%), but without statistical significance (p = 0.514). The patients who started RRT within 24 hours with the Sequential Organ Failure Assessment (SOFA) score of 1–3 were twice likely to recover renal function in relation to the patients with the SOFA score of 4 or higher [odds ratio (OR) = 2.01; 95% confidence interval (CI): 1.37–2.95; p < 0.001], while septic patients had a 62% lower chance of renal function recovery in relation to non-septic patients (OR = 0.38; 95% CI: 0.18–0.82; p = 0.013). In the “late” RRT group, it was found that non-diabetic patients had 3.8 times greater chance for renal function recovery compared to diabetic patients (OR = 3.53; 95% CI: 1.27–9.83; p = 0.016). Conclusions. Patients with the early initiation of RRT had significantly improved 28-day survival.
format	article
author	Knežević Violeta Azaševac Tijana Šibalić-Simin Marija Sladojević Vesna Urošević Ivana Ćelić Dejan
author_facet	Knežević Violeta Azaševac Tijana Šibalić-Simin Marija Sladojević Vesna Urošević Ivana Ćelić Dejan
author_sort	Knežević Violeta
title	Early initiation of renal replacement therapy improves survival in patients with acute kidney injury
title_short	Early initiation of renal replacement therapy improves survival in patients with acute kidney injury
title_full	Early initiation of renal replacement therapy improves survival in patients with acute kidney injury
title_fullStr	Early initiation of renal replacement therapy improves survival in patients with acute kidney injury
title_full_unstemmed	Early initiation of renal replacement therapy improves survival in patients with acute kidney injury
title_sort	early initiation of renal replacement therapy improves survival in patients with acute kidney injury
publisher	Military Health Department, Ministry of Defance, Serbia
publishDate	2021
url	https://doaj.org/article/bb7572ce722c4d87964538cedaa818e8
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Early initiation of renal replacement therapy improves survival in patients with acute kidney injury

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