Late initiation of renal replacement therapy is associated with worse outcomes in acute kidney injury after major abdominal surgery
IntroductionAbdominal surgery is probably associated with a greater likelihood of acute kidney injury (AKI). The aim of this study was to evaluate whether early or late start of renal replacement therapy (RRT) defined by simplified RIFLE (sRIFLE) classification in AKI patients after major abdominal surgery will affect outcome.
Methods: A multicenter prospective observational study based on the NSARF study group (National Taiwan University Surgical ICU Associated Renal Failure) database.
98 patients (41 female, mean age 66.4+/-13.9 years) who underwent acute RRT according to local indications for post-major abdominal surgery AKI between January 1, 2002 and December 31, 2005 were selected. The demographic data, comorbid diseases, types of surgery and RRT, as well as the indications for RRT were documented.
The patients were divided into early dialysis (sRIFLE-0 or Risk) and late dialysis (LD, sRIFLE -Injury or Failure) groups. Then we measured and recorded patients'outcome including in-hospital mortality and RRT wean-off until June 30, 2006.
Results: The in-hospital mortality was compared as endpoint.
Fifty-seven patients (58.2 %) died during hospitalization. LD [hazard ratio (HR) 1.846; P=0.027], old age (HR 2.090; P=0.010), cardiac failure (HR 4.620; P<0.001), pre-RRT SOFA score (HR 1.152; P<0.001) were independent indicators for in-hospital mortality.
Conclusions: The findings of this study support earlier initiation of acute RRT, and also underscore the importance of predicting prognoses of major abdominal surgical patients with AKI by using RIFLE classification.
Author: Chih-Chung ShiaoVin-Cent WuWen-Yi LiYu-Feng LinFu-Chang HuGuang-Huar YoungChin-Chi KuoTze-Wah KaoDown-Ming HuangYung-Ming ChenPi-Ru TsaiShuei-Liong LinNai-Kuan ChouTzu-Hsin LinYu-Chang YehChih-Hsien WangAnne ChouWen-Je KoKwan-Dun Wuthe NSARF Study
Published on: 2009-10-30
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
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