Impact of timing of initiation of dialysis on mortality of patients with acute kidney injury

Reginaldo Passoni Dos Santos,Raissa Fritz Schmitt,Danielle Fernanda Miner De Oliveira,Vinicius Ferreira De Barros,Luis Alberto Batista Peres,Letícia Giroldo Vieira,Ariana Rodrigues Da Silva Carvalho

doi:10.34172/jre.2021.07

Abstract

Introduction: In Brazil, primary studies on this issue are still limited and the ideal timing of initiation of dialysis in severe acute kidney injury (AKI) still generates disagreements among experts. Objectives: To assess if the timing of initiation of dialysis is associated with the mortality of patients with AKI in intensive care unit (ICU). Patients and Methods: We retrospectively analyzed medical records of patients that developed severe AKI in the ICU. Bivariate analysis was carried out to compare data between groups of patients who underwent early dialysis (ED - initiated up to two days after the AKI diagnosis) and late dialysis (LD – initiated more than two days after the AKI diagnosis), while multivariate logistic regression was applied to identify factors associated with mortality. Results: Of the 76 patients included in the study, 27 (35.5%) were allocated in the ED group and 49 (64.5%) in the LD group. LD group had a higher frequency of sepsis [26 (53%) vs. 12 (44%); P = 0.472], while the ED group had a higher median number of dialysis sessions (6 vs. 3; P = 0.477) and higher total median time on dialysis (17.5 h vs. 13 h; P = 0.629). The overall mortality rate was 61.8% (n = 47) and of 76% (n = 22) in the ED group. The patients’ serum creatinine level at admission in the ICU was the only statistically significant risk factor for death [OR= 0.453 (95% CI= 0.257–0.801); P = 0.006]. Conclusion: The overall and in the ED group mortality rate was elevated, however, the timing of initiation of dialysis did not show statistically significant association with death. The serum creatinine at ICU admission seems to be an important mortality predictor.

Highlights

In Brazil, primary studies on this issue are still limited and the ideal timing of initiation of dialysis in severe acute kidney injury (AKI) still generates disagreements among experts
During the study period, 613 patients were diagnosed with AKI in the intensive care unit (ICU), of whom 238 (38.8%) had severe AKI and, of these, the 76 (31.9%) undergoing dialysis were included in the present study
Urine output in the first 24 hours of admission to the ICU was lower in the early dialysis (ED) group (350 mL vs. 1600 mL; P ≤ 0.001), while the median of sequential organ failure assessment (SOFA) score was lower in the late dialysis (LD) group (11 points vs. 13 points; P = 0.019)

Summary

Introduction

In Brazil, primary studies on this issue are still limited and the ideal timing of initiation of dialysis in severe acute kidney injury (AKI) still generates disagreements among experts. Objectives: To assess if the timing of initiation of dialysis is associated with the mortality of patients with AKI in intensive care unit (ICU). In 2016, Gaudry et al [6], at France, and Zarbock et al [7], at Germany published data from two studies on the impact of timing of early dialysis (ED) initiation on the mortality of critical ill AKI patients. In this same sense, Brazilian researchers conducting a systematic review, concluding that the early initiation of dialysis does not attribute greater survival to patients with severe AKI [8]

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Conclusion