Timing of continuous renal replacement therapy in sepsis patients with acute kidney injury

Abstract

Objective To explore the optimal timing for continuous renal replacement therapy (CRRT) in sepsis patients with acute kidney injury (AKI). Methods A total of 112 sepsis patients with AKI treated with CRRT in ICU of Zhejiang Provincial People's Hospital from January 2011 to January 2015 were divided into the early CRRT group (AKI-stage 1 or stage 2, 52 cases) and late CRRT group (AKI-stage 3, 60 cases) according to their Kidney Disease: Improving Global Outcomes (KDIGO)-AKI stage before initiation of CRRT. The acute physiology and chronic health evaluation (APACHE) Ⅱ score, sequential organ failure (SOFA) score, mean arterial pressure, serum lactate, WBC, hemoglobin, blood platelet count, duration of mechanical ventilation, length of ICU stay, 28 d survival rate and fatality rate of inpatient were compared between the two groups. Kaplan-Meier curves obtained with the Log-rank test were plotted to demonstrate the differences in patients' survival between the two groups. Results There were no significant differences between the two groups in APACHE Ⅱ score, mean arterial pressure, serum lactate and blood platelet count before CRRT (all P>0.05). In the late CRRT group, the SOFA score [(9.6 ± 4.3) vs. (7.4 ± 2.9), t=3.171, P=0.002], WBC [(15 ± 8) × 109/L vs. (12 ± 9) × 109/L, t=2.273, P=0.025] and fatality rate of inpatient [70% (42/60) vs. 50.0% (26/52), χ2=4.672, P=0.031] were much higher, and hemoglobin [(89 ± 25) g/L vs. (100 ± 27) g/L, t=2.107, P=0.037], 28 d survival rate [40.0% (24/60) vs. 61.54% (32/52), χ2=5.169, P=0.023] were much lower than those in the early CRRT group. However, the duration of mechanical ventilation and length of ICU stay showed no significant differences between the two groups (all P>0.05). Furthermore, the Log-rank test of Kaplan-Meier curves also showed that survival rate in the early CRRT group was better than that in the late RRT group (χ2=12.169, P<0.001). Conclusion The mortality is really high in patients with sepsis-associated AKI, and the optimal timing of initiating CRRT may predate in patients with early renal progress to AKI-3 phase. Key words: Sepsis; Acute kidney injury; Continuous renal replacement therapy; Timing