Early mortality risk factors at the beginning of continuous renal replacement therapy for acute kidney injury

Abstract

Introduction: Acute kidney injury (AKI) occurs in more than 50% of critically ill patients, 23% need renal replacement therapy. The aim of our study is to identify early mortality risk factors at the beginning of continuous renal replacement therapy (CRRT) for AKI. Methods: A cohort study was performed in adult patients with AKI who required CRRT in the intensive care unit of a university hospital. We did a bivariate and multivariate analysis for early death, defined as death within 24 h of onset of CRRT. Results: 214 AKI patient required CRRT, The mean age was 61.5 years (± 15.47), 57.73% men. The most frequent cause of AKI was sepsis in 30.9% of cases. A total of 774 CRRT days were conducted with a median of 3 days per patient (1–19). Mean Charlson comorbidity index was 5.22 (± 2.85), APACHE II score 29.65 (± 6.66), total non-renal SOFA had a median of 11 (range 6–18) at the time of starting therapy. The hospital mortality was 68.4% and early mortality was 19.07%. In multivariate analysis for early death: lactate levels (p = 0.007), glucose (p = 0.01) and age (p = 0.02) were independent risk factors with AUC of 0.73. Conclusions: Patients with AKI on CRRT have high mortality. Age, Low glucose and high lactate at onset of CRRT are independent risk factors of early death. We need an external validation.

Keywords

• acute kidney injury
• renal replacement therapy
• mortality
• critical illness
• renal insufficiency