Relationship between the timing of initiation of continuous renal replacement therapy and the prognosis of patients with sepsis-associated acute kidney injury

Abstract

To investigate the relationship between the timing of initiation of continuous renal replacement therapy (CRRT) and the prognosis of patients with sepsis associated-acute kidney injury (SA-AKI). The clinical data of SA-AKI patients undergoing CRRT in intensive care unit (ICU) of Ningbo First Hospital from January 2017 to November 2019 were retrospectively analyzed. According to the guidelines for Kidney Disease: Improving Global Outcomes (KDIGO), patients with AKI who started CRRT in stage 1 or 2 were included in the early treatment group, and those started CRRT in stage 3 were included in the late treatment group. The general clinical data, length of ICU stay, total length of hospital stay, 28-day and 90-day mortality, CRRT duration, 28-day and 90-day renal replacement therapy (RRT) disengagement rate, 28-day and 90-day RRT dependence rate in the survival patients were compared between the two groups. Kaplan-Meier survival analysis was performed to assess the 90-day cumulative survival rate of patients with SA-AKI between two groups. A total of 244 SA-AKI patients were enrolled in this study, including 71 patients in the early treatment group and 173 patients in the late treatment group. There were no significant differences in age, gender composition, acute physiology and chronic health evaluation II (APACHE II), proportion of surgical patients, infection site and anticoagulation program between the two groups. The CRRT duration in the early group was significantly shorter than that in the late group [hours: 26.0 (12.0, 49.0) vs. 41.0 (20.8, 87.0), P < 0.01], but there were no significant differences in the length of ICU stay [days: 9.0 (4.0, 15.0) vs. 10.0 (4.5, 18.0)], total length of hospital stay [days: 17.0 (10.0, 30.0) vs. 18.0 (10.0, 32.0)], 28-day mortality (45.1% vs. 48.0%), 90-day mortality (46.4% vs. 51.4%), 28-day RRT disengagement rate (49.3% vs. 45.1%) and 90-day RRT disengagement rate (52.1% vs. 47.4%) between the early treatment group and late treatment group (all P > 0.05). There were also no significant differences in 28-day RRT dependence rate [10.3% (4/39) vs. 13.3% (12/90)] and 90-day RRT dependence rate [2.6% (1/38) vs. 2.4% (2/84)] between early treatment group and late treatment group (both P > 0.05). Kaplan-Meier survival analysis suggested that there was no significant difference in the 90-day cumulative survival rate between two groups (Log-Rank test: χ2 = 0.791, P = 0.374). Early initiation of CRRT treatment in SA-AKI patients can reduce the duration of CRRT, but has no effect on length of ICU stay, total length of hospital stay, renal function recovery and mortality. At present, the optimal timing for initiation of CRRT in patients with SA-AKI remains unknown.