Severe acute kidney injury not treated with renal replacement therapy: characteristics and outcome.

Details

Serval ID
serval:BIB_60A86BBB3A85
Type
Article: article from journal or magazin.
Collection
Publications
Title
Severe acute kidney injury not treated with renal replacement therapy: characteristics and outcome.
Journal
Nephrology, Dialysis, Transplantation
Author(s)
Schneider A.G., Uchino S., Bellomo R.
ISSN
1460-2385 (Electronic)
ISSN-L
0931-0509
Publication state
Published
Issued date
2012
Peer-reviewed
Oui
Volume
27
Number
3
Pages
947-952
Language
english
Notes
Publication types: Comparative Study ; Journal Article ; Research Support,, pdf : Original Article
Abstract
BACKGROUND: Only a proportion of critically ill patients with severe [RIFLE (Risk, Injury, Failure, Loss, End-stage renal disease) criteria, class-F] acute kidney injury (AKI) appear to receive renal replacement therapy (RRT). The aim of this study was to study the characteristics and outcome of patients with severe (RIFLE-F) AKI who did not receive RRT.
METHODS: We identified all consecutive patients admitted to our institution that developed RIFLE-F AKI by creatinine criteria over a 3-year period and did not receive RRT, and compared their characteristics and outcomes with those of RIFLE-F RRT-treated patients.
RESULTS: Within the study period, 20,126 patients were admitted to our institution for >24 h. Among them, 2949 were admitted to the intensive care unit (ICU) and 195 developed RIFLE-F AKI. Of these, 90 received RRT (RRT patients) and 105 did not (no-RRT patients). Compared with RRT patients, no-RRT patients were similar in terms of age, gender and ward of origin. However, they had a shorter median ICU stay (2.7 versus 7.9 days; P < 0.001), required less mechanical ventilation (56.2 versus 70%; P < 0.05) and had a lower mean Acute Physiology and Chronic Health Evaluation III score (82.7 versus 86.7; P < 0.05). The two main reasons these patients did not receive RRT were limitations of medical therapy (LOMT) orders in 41 (39%) cases and expected renal functional improvement in 59 (56.2%). Mortality in no-RRT patients was 58.1% compared with 55.5% in the RRT group (P = 0.72). After exclusion of LOMT patients, the mortality of the no-RRT group, although lower than that of the RRT group, remained high (30.5 versus 55%; P < 0.001). Most of these deaths occurred after ICU discharge and appeared secondary to underlying chronic diseases or recurrence of the initial insult.
CONCLUSIONS: After exclusion of LOMT patients, about a third of critically ill patients with severe (RIFLE-F) AKI did not receive RRT. A third of these patients died in hospital. The timing of the deaths and their underlying causes do not suggest that a broader application of RRT would have changed patient outcomes.
Keywords
Acute Kidney Injury/mortality, Acute Kidney Injury/therapy, Aged, Critical Illness/mortality, Female, Humans, Intensive Care Units/statistics & numerical data, Male, Renal Replacement Therapy/mortality, Retrospective Studies, Survival Rate, Treatment Outcome
Pubmed
Open Access
Yes
Create date
26/11/2014 23:05
Last modification date
20/08/2019 15:18
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