Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury

Sean M. Bagshaw, Shigehiko Uchino, Rinaldo Bellomo, Hiroshi Morimatsu, Stanislao Morgera, Miet Schetz, Ian Tan, Catherine Bouman, Ettiene Macedo, Noel Gibney, Ashita Tolwani, Heleen M. Oudemans-van Straaten, Claudio Ronco, John A. Kellum

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Purpose: The aim of this study is to evaluate the relationship between timing of renal replacement therapy (RRT) in severe acute kidney injury and clinical outcomes. Methods: This was a prospective multicenter observational study conducted at 54 intensive care units (ICUs) in 23 countries enrolling 1238 patients. Results: Timing of RRT was stratified into "early" and "late" by median urea and creatinine at the time RRT was started. Timing was also categorized temporally from ICU admission into early (<2 days), delayed (2-5 days), and late (>5 days). Renal replacement therapy timing by serum urea showed no significant difference in crude (63.4% for urea ≤24.2 mmol/L vs 61.4% for urea >24.2 mmol/L; odds ratio [OR], 0.92; 95% confidence interval [CI], 0.73-1.15; P = .48) or covariate-adjusted mortality (OR, 1.25; 95% CI, 0.91-1.70; P = .16). When stratified by creatinine, late RRT was associated with lower crude (53.4% for creatinine >309 μmol/L vs 71.4% for creatinine ≤309 μmol/L; OR, 0.46; 95% CI, 0.36-0.58; P < .0001) and covariate-adjusted mortality (OR, 0.51; 95% CI, 0.37-0.69; P < .001). However, for timing relative to ICU admission, late RRT was associated with greater crude (72.8% vs 62.3% vs 59%, P < .001) and covariate-adjusted mortality (OR, 1.95; 95% CI, 1.30-2.92; P = .001). Overall, late RRT was associated with a longer duration of RRT and stay in hospital and greater dialysis dependence. Conclusion: Timing of RRT, a potentially modifiable factor, might exert an important influence on patient survival. However, this largely depended on its definition. Late RRT (days from admission) was associated with a longer duration of RRT, longer hospital stay, and higher dialysis dependence.

Original languageEnglish
Pages (from-to)129-140
Number of pages12
JournalJournal of Critical Care
Volume24
Issue number1
DOIs
Publication statusPublished - 1 Mar 2009

Cite this

Bagshaw, S. M., Uchino, S., Bellomo, R., Morimatsu, H., Morgera, S., Schetz, M., ... Kellum, J. A. (2009). Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury. Journal of Critical Care, 24(1), 129-140. https://doi.org/10.1016/j.jcrc.2007.12.017
Bagshaw, Sean M. ; Uchino, Shigehiko ; Bellomo, Rinaldo ; Morimatsu, Hiroshi ; Morgera, Stanislao ; Schetz, Miet ; Tan, Ian ; Bouman, Catherine ; Macedo, Ettiene ; Gibney, Noel ; Tolwani, Ashita ; Oudemans-van Straaten, Heleen M. ; Ronco, Claudio ; Kellum, John A. / Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury. In: Journal of Critical Care. 2009 ; Vol. 24, No. 1. pp. 129-140.
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abstract = "Purpose: The aim of this study is to evaluate the relationship between timing of renal replacement therapy (RRT) in severe acute kidney injury and clinical outcomes. Methods: This was a prospective multicenter observational study conducted at 54 intensive care units (ICUs) in 23 countries enrolling 1238 patients. Results: Timing of RRT was stratified into {"}early{"} and {"}late{"} by median urea and creatinine at the time RRT was started. Timing was also categorized temporally from ICU admission into early (<2 days), delayed (2-5 days), and late (>5 days). Renal replacement therapy timing by serum urea showed no significant difference in crude (63.4{\%} for urea ≤24.2 mmol/L vs 61.4{\%} for urea >24.2 mmol/L; odds ratio [OR], 0.92; 95{\%} confidence interval [CI], 0.73-1.15; P = .48) or covariate-adjusted mortality (OR, 1.25; 95{\%} CI, 0.91-1.70; P = .16). When stratified by creatinine, late RRT was associated with lower crude (53.4{\%} for creatinine >309 μmol/L vs 71.4{\%} for creatinine ≤309 μmol/L; OR, 0.46; 95{\%} CI, 0.36-0.58; P < .0001) and covariate-adjusted mortality (OR, 0.51; 95{\%} CI, 0.37-0.69; P < .001). However, for timing relative to ICU admission, late RRT was associated with greater crude (72.8{\%} vs 62.3{\%} vs 59{\%}, P < .001) and covariate-adjusted mortality (OR, 1.95; 95{\%} CI, 1.30-2.92; P = .001). Overall, late RRT was associated with a longer duration of RRT and stay in hospital and greater dialysis dependence. Conclusion: Timing of RRT, a potentially modifiable factor, might exert an important influence on patient survival. However, this largely depended on its definition. Late RRT (days from admission) was associated with a longer duration of RRT, longer hospital stay, and higher dialysis dependence.",
keywords = "Acute kidney injury, Acute renal failure, Critical illness, Delay, Dialysis, Hemofiltration, Length of stay, Mortality, Renal recovery, Renal replacement therapy, Timing",
author = "Bagshaw, {Sean M.} and Shigehiko Uchino and Rinaldo Bellomo and Hiroshi Morimatsu and Stanislao Morgera and Miet Schetz and Ian Tan and Catherine Bouman and Ettiene Macedo and Noel Gibney and Ashita Tolwani and {Oudemans-van Straaten}, {Heleen M.} and Claudio Ronco and Kellum, {John A.}",
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Bagshaw, SM, Uchino, S, Bellomo, R, Morimatsu, H, Morgera, S, Schetz, M, Tan, I, Bouman, C, Macedo, E, Gibney, N, Tolwani, A, Oudemans-van Straaten, HM, Ronco, C & Kellum, JA 2009, 'Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury' Journal of Critical Care, vol. 24, no. 1, pp. 129-140. https://doi.org/10.1016/j.jcrc.2007.12.017

Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury. / Bagshaw, Sean M.; Uchino, Shigehiko; Bellomo, Rinaldo; Morimatsu, Hiroshi; Morgera, Stanislao; Schetz, Miet; Tan, Ian; Bouman, Catherine; Macedo, Ettiene; Gibney, Noel; Tolwani, Ashita; Oudemans-van Straaten, Heleen M.; Ronco, Claudio; Kellum, John A.

In: Journal of Critical Care, Vol. 24, No. 1, 01.03.2009, p. 129-140.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury

AU - Bagshaw, Sean M.

AU - Uchino, Shigehiko

AU - Bellomo, Rinaldo

AU - Morimatsu, Hiroshi

AU - Morgera, Stanislao

AU - Schetz, Miet

AU - Tan, Ian

AU - Bouman, Catherine

AU - Macedo, Ettiene

AU - Gibney, Noel

AU - Tolwani, Ashita

AU - Oudemans-van Straaten, Heleen M.

AU - Ronco, Claudio

AU - Kellum, John A.

PY - 2009/3/1

Y1 - 2009/3/1

N2 - Purpose: The aim of this study is to evaluate the relationship between timing of renal replacement therapy (RRT) in severe acute kidney injury and clinical outcomes. Methods: This was a prospective multicenter observational study conducted at 54 intensive care units (ICUs) in 23 countries enrolling 1238 patients. Results: Timing of RRT was stratified into "early" and "late" by median urea and creatinine at the time RRT was started. Timing was also categorized temporally from ICU admission into early (<2 days), delayed (2-5 days), and late (>5 days). Renal replacement therapy timing by serum urea showed no significant difference in crude (63.4% for urea ≤24.2 mmol/L vs 61.4% for urea >24.2 mmol/L; odds ratio [OR], 0.92; 95% confidence interval [CI], 0.73-1.15; P = .48) or covariate-adjusted mortality (OR, 1.25; 95% CI, 0.91-1.70; P = .16). When stratified by creatinine, late RRT was associated with lower crude (53.4% for creatinine >309 μmol/L vs 71.4% for creatinine ≤309 μmol/L; OR, 0.46; 95% CI, 0.36-0.58; P < .0001) and covariate-adjusted mortality (OR, 0.51; 95% CI, 0.37-0.69; P < .001). However, for timing relative to ICU admission, late RRT was associated with greater crude (72.8% vs 62.3% vs 59%, P < .001) and covariate-adjusted mortality (OR, 1.95; 95% CI, 1.30-2.92; P = .001). Overall, late RRT was associated with a longer duration of RRT and stay in hospital and greater dialysis dependence. Conclusion: Timing of RRT, a potentially modifiable factor, might exert an important influence on patient survival. However, this largely depended on its definition. Late RRT (days from admission) was associated with a longer duration of RRT, longer hospital stay, and higher dialysis dependence.

AB - Purpose: The aim of this study is to evaluate the relationship between timing of renal replacement therapy (RRT) in severe acute kidney injury and clinical outcomes. Methods: This was a prospective multicenter observational study conducted at 54 intensive care units (ICUs) in 23 countries enrolling 1238 patients. Results: Timing of RRT was stratified into "early" and "late" by median urea and creatinine at the time RRT was started. Timing was also categorized temporally from ICU admission into early (<2 days), delayed (2-5 days), and late (>5 days). Renal replacement therapy timing by serum urea showed no significant difference in crude (63.4% for urea ≤24.2 mmol/L vs 61.4% for urea >24.2 mmol/L; odds ratio [OR], 0.92; 95% confidence interval [CI], 0.73-1.15; P = .48) or covariate-adjusted mortality (OR, 1.25; 95% CI, 0.91-1.70; P = .16). When stratified by creatinine, late RRT was associated with lower crude (53.4% for creatinine >309 μmol/L vs 71.4% for creatinine ≤309 μmol/L; OR, 0.46; 95% CI, 0.36-0.58; P < .0001) and covariate-adjusted mortality (OR, 0.51; 95% CI, 0.37-0.69; P < .001). However, for timing relative to ICU admission, late RRT was associated with greater crude (72.8% vs 62.3% vs 59%, P < .001) and covariate-adjusted mortality (OR, 1.95; 95% CI, 1.30-2.92; P = .001). Overall, late RRT was associated with a longer duration of RRT and stay in hospital and greater dialysis dependence. Conclusion: Timing of RRT, a potentially modifiable factor, might exert an important influence on patient survival. However, this largely depended on its definition. Late RRT (days from admission) was associated with a longer duration of RRT, longer hospital stay, and higher dialysis dependence.

KW - Acute kidney injury

KW - Acute renal failure

KW - Critical illness

KW - Delay

KW - Dialysis

KW - Hemofiltration

KW - Length of stay

KW - Mortality

KW - Renal recovery

KW - Renal replacement therapy

KW - Timing

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DO - 10.1016/j.jcrc.2007.12.017

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JO - Journal of Critical Care

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