IMPACT OF TIMING OF RENAL REPLACEMENT THERAPY INITIATION ON OUTCOME OF ACUTE KIDNEY INJURY IN SEPTIC PATIENTS

Abstract

Objective: To identify whether the timing of initiation of continuous renal replacement therapy affects outcome in septic patients with acute kidney injury in term of 28 days mortality. Study Design: Cross sectional analytical study. Place and Duration of Study: This research was conducted at department of Anaesthesiology and critical care unit of the Aga Khan University Hospital, Karachi, from Oct 2018 to Jun 2019. Methodology: The study reviewed all adult patients aged >18 years who developed acute kidney injury after septic shock and required continuous renal replacement therapy in surgical intensive care unit. Considering the value of blood urea nitrogen, patients were classified into two groups. One was in early group that‟s was defined as blood urea nitrogen value of <100 mg/dl just before continuous renal replacement therapy initiation while the patients who have blood urea nitrogen value of ≥100 mg/dl just prior to continuous renal replacement therapy initiation were classified as late group. Kaplan-Meier survival analysis was performed and median survival was computed. Results: Forty patients were included for analysis. There were thirty patients (75%) in early group in whom continuous renal replacement therapy was started with mean blood urea nitrogen of 66 ± 20.2 mg/dL and 10 (25%) patients were in late group with mean blood urea nitrogen of 137 ± 28.4 mg/dL. The overall survival rates in both groups were 49.6%, and 10.4% at 10 and 25 days, respectively. Median survival time was not statistically significant between early and late continuous renal replacement therapy groups 9 (2.74) vs. 11 (0.41); p=0.997. Conclusion: Septic patients who developed acute kidney injury and started continuous renal replacement therapy did not showed in any mortality benefit among both groups.

Keywords

• acute kidney injury
• intensive care
• renal replacement therapy
• sepsis