Continuous Renal Replacement Therapy In ICU Research Articles

Comparison of effect of continuous renal replacement therapy in AKI 2 stage and AKI 3 stage on the prognosis of critical patients with acute kidney injury

Objective To compare the effect of continuous renal replacement therapy(CRRT) in AKI 2 stage and AKI 3 stage on the prognosis of critical patients with acute kidney injury(AKI). Methods From February 2017 to October 2018, 56 cases of critical patients with AKI 2-3 stage who underwent CRRT in ICU of our hospital were selected as the research objects. According to the new AKI criteria formulated by the international organization for improving the prognosis of global kidney disease (KDIGO) in 2012, the patients were divided into AKI 2 stage group (n=26) and AKI3 stage group (n=30). The prognostic indexes (length of hospital stay, duration of CRRT, renal function recovery rate in 28 days, all-cause mortality in 28 days) were compared between two groups. The acute physiology and chronic healthⅡ(APACEⅡ)scores were compared between two groups before and after treatment. Survival analysis was performed by Kaplan-Meier in two groups. Results The duration of CRRT [(188.6±112.5)h vs. (96.3±44.7)h], all-cause mortality in 28 d[66.7%(20/30) vs.15.4%(4/26)] of AKI 3 stage group was significantly higher than that of AKI 2 stage group (P<0.05) and the renal function recovery rate in 28 days[36.7%(11/30) vs.92.3%(24/26)] of AKI 3 stage group was significantly lower than that of AKI 2 stage group (P<0.05). After treatment, the APACEⅡscores were significantly reduced in two groups (P<0.05) and the APACEⅡscores[(23.4±3.6) scores vs.(19.8±2.1) scores] of the AKI 3 stage group was significantly higher than that of AKI 2 stage group (P<0.05). The median survival time (34 days vs. 109 days) of AKI 3 stage group was significantly shorter than that of AKI 2 stage group (P<0.05). Conclusions CRRT initiation in AKI 2 stage could significantly reduce all-cause mortality in 28 days, prolong the median survival time and improve the health condition of patients. Key words: Acute Kidney Injury; Renal Replacement Therapy

142 TIMING OF NEPHROLOGY REFERRAL AND OUTCOME IN ACUTE KIDNEY INJURY PATIENTS RECEIVING CONTINUOUS RENAL REPLACEMENT THERAPY

Category: Epidemiology and Outcomes from AKI Presenter: Dr ASIAH USAMAH Keywords: Acute kidney injury, continuous renal replacement therapy, timing of referral Timing of nephrology referral in critically ill acute kidney injury patients is a subject of debate. Some studies have found that late nephrology referral is associated with poor prognosis. No consensus exists on the best timing of nephrology consult and initiation of CRRT. To determine the factors and outcome in relation to timing of nephrology referral in acute kidney injury (AKI) patients receiving continuous renal replacement therapy (CRRT). This is a retrospective study involving all AKI patients aged more than 18 years old receiving CRRT in ICU, HKL from October 2016 till April 2017. A total of 107 patients were screened and 68 patients were included in the study. Patients were divided into 2 categories based on timing of referral from onset of AKI. Early referral is defined as referral less than 48 hours while late referral is more than 48 hours. AKI is defined as per KDIGO guideline. Data were collected from ICU local database and analysed using SPSS version 20. Categorical and demographic data were expressed as frequency (n) and percentage (%), whilst continuous variables was expressed as mean and standard deviation (SD). Sixty eight patients, comprising 51 early referral and 17 late referral were analysed. Patients who were referred late had higher mortality (n=15, 88.2%) compared to early referral group (n=35, 15.7%, p=0.22). Patients who were in the late referral group also had longer length of stay, 12days (3.5-22) compared to patients in early referral group, 4 days (2-10), p=0.049. There were no significant difference in blood urea, serum creatinine, serum lactate, bicarbonate, serum potassium and urine output volume at referrals in both groups. Late referral group had higher mortality, albeit statistically not significant most likely due to small sample size. This study did not include disease severity as a confounding factor for mortality.