Early initiation of dialysis: mortality and renal function recovery in acute kidney injury patient

Ginivaldo Victor Ribeiro Do Nascimento,Juliana Maria Gera Abrão,André Luis Balbi,Daniela Ponce

doi:10.5935/0101-2800.20120022

Abstract

The decision of when to start dialysis in Acute Kidney Injury (AKI) patients with overt uremia is strongly established, however, when blood urea nitrogen (BUN) levels is < 100 mg/dL the timing of initiation of dialysis remains uncertain. The aim of this study was to assess mortality and renal function recovery AKI patients started on dialysis at different BUN levels. This was a retrospective study performed at Medical School Hospital, São Paulo, Brazil, enrolling 86 patients underwent to dialysis. Dialysis was started when BUN < 75 mg/dl in 23 patients (Group I) and BUN > 75 mg/dl in 63 patients (Group II). Hypervolemia and mortality were higher in Group I than in Group II (65.2% vs. 14.3% - p < 0.05, 39.1% vs. 68.9%- p < 0.05, respectively). Among survivors, the rate of renal function recovery was higher in Group I (71.4% and 36.8%, respectively--p < 0.05). Multivariate analysis showed that sepsis, age > 60 years, peritoneal dialysis and BUN > 75 mg/dl at dialysis initiation were independently related with mortality. Lower mortality and higher renal function recovery rates were associated with early dialysis initiated at lower BUN levels in AKI patients.

Highlights

The decision of when to start dialysis in Acute Kidney Injury (AKI) patients with overt uremia is strongly established, when blood urea nitrogen (BUN) levels is < 100 mg/dL the timing of initiation of dialysis remains uncertain
Multivariate analysis showed that sepsis, age > 60 years, peritoneal dialysis and BUN > 75 mg/dl at dialysis initiation were independently related with mortality
Based on the values established in the literature, the primary goal of this study was to evaluate mortality among patients with AKI who were started on dialysis at different BUN levels

Summary

Introduction

The decision of when to start dialysis in Acute Kidney Injury (AKI) patients with overt uremia is strongly established, when blood urea nitrogen (BUN) levels is < 100 mg/dL the timing of initiation of dialysis remains uncertain. The decision of when to start dialysis in AKI patients with overt uremia is strongly established and historically blood urea nitrogen (BUN) levels higher than 100mg/dL is associated with higher mortality In these situations, the beginning of dialysis should not be delayed.[8,9] when BUN levels is < 100 mg/dL the timing of initiation of dialysis vary widely and this clinical practice remains uncertain.[8] Palevsky et al.,[7] in a review, emphasize that the optimal management of renal replacement therapy is still unclear, and conclude that further studies are necessary to evaluate the timing of therapy initiation in AKI patients

Objectives

Methods

Results