Comparison of early continuous hemodiafiltration vs. delayed continuous hemodiafiltration in patients of acute kidney injury (AKI) with septic shock

Abstract

Introduction: Acute kidney injury (AKI) is a common clinical condition among critically ill patients, incredibly complicated with sepsis. The study aims to compare mortality rates in early and late renal replacement therapy initiation in critically ill patients with AKI and septic shock. Methods and Material: We carried out a retrospective, randomized, single-centre study of early vs. late RRT-implementation strategies for critically ill patients with sepsis and AKI in ICU at our Institute for one year (July 2017 to July 2018). AKI was defined and categorized by RIFLE criteria. Results: A total of 59 deaths were observed by day 28 (25 in the early RRT group and 34 in the delayed RRT group). The survival rates were estimated using the Kaplan–Meier method and compared with a log-rank test (p=0.007). The Kaplan–Meier estimate of the overall survival at day 28 was 49.1% (95% CI, 45.0 to 52.9). Conclusions: Among critically ill patients with sepsis with AKI, we observed reduced 28-day mortality in early RRT than delayed RRT initiation. Our study proves the benefit of early implementation of CRRT over delayed therapy with better 28-day survival in the early RRT group.