| Objective: Acute renal insufciency (AKI) is a common complication of critically illness. Some studies have reported that AKI patients in intensive care unit (ICU) have an incidence of 1% -25%,which resulting to a high mortality.Although in the past 50 years,renal replacement therapy has been the primary treatment of AKI,but the timing of continuous renal replacement therapy (CRRT) treatment remains controversial.In 2005,the Acute Kidney Injury Network (AKIN) proposed AKIN criteria assert a new definition for AKI. Up to now, the study of using AKIN criteria as the timing of CRRT to assess prognosis of patients is few.The purpose of this present study is to find the"optimal timing"for starting CRRT using AKIN criteria as the timing of CRRT. Further more, we analyzed the correlation between AKIN stage at the start of CRRT and 28,90 and 180-day survival rate after CRRT.We also investigated the correlation of AKIN stage with the kidney function in the 28,90 and 180-day survivors.Methods: A single-center retrospective analysis was performed on the data of 42 critically ill patients with AKI, treated with Continuous venovenous haemofiltration(CVVH), during 2009-1-1 to 2010-10-31 in intensive care unit (ICU) of The Furth Hospital of Hebei Medical University. The patients were assigned to three groups according to the AKIN criteria (baseline severity of AKI at the start of CRRT). There are AKIN stage-1group (12 cases), stage-2 group (17 cases), and stage-3 group (13 cases). Information such as sex, age, weight, diagnosis, sepsis-related organ failure assessment (SOFA) score, Acute physiology and chronic heathy II (APACHE II)score, baseline creatinine, creatinine before and after CRRT, CRRT dose, duration time of CRRT, stay days of ICU, survival, and kidney outcome conditions at 28, 90 and 180 days after CRRT was collected. The major prognostic indicator was the 28-day, 90-day and 180-day survival rate, and kidney function in the 28, 90 and 180-day survivors was also conducted.Results: A total of 42 severe AKI patients were selected in to the study. Almost all of the medical characteristics of patients were not significantly difference between the three groups except"gender". The male patients in three groups were 28, and there were 11, 11 and 6 in AKIN stage-1,2 and 3 group respectively(P = 0.03). The average age in AKIN stage-1,2 and 3 group were 63.5+4, 68.3+4 , 61+3 years old respectively(P = 0.405). The APACHE II and SOFA scores were not significantly difference. Nine (75%), 11(67%)and 12(92%)patients in three groups were treated with mechanical ventilation respectively(P = 0.505). The hemodynamic instability patients, using vasoactive drugs, were 11, 16 and 11 respectively, which were not significantly difference(P = 0.957). All the patients were treated with continuous venovenous hemofifltration (CVVH) with AN69 filter. The average filter life was15.78 hours, and the average CVVH dose was 25.52ml/Kg.h, and the average CVVH treatment time was116.5 hours.The survival rate of 28,90,180 days after CRRT in 42 patients was 53.7% (22/41, 1 lost to follow up), 37.5% (15/40, 2 lost to follow up), and 35% (14/40, 2 lost to follow up). The corresponding 28-day survival rate in AKIN stage-1, 2 and 3 groups were 58.3%(7/12), 47.1%(8/17)and 58.3%(7/12) respectively (P=0.814),and 90-day survival rate were 50.0%(6/12),25.0%(4/16)and 41.7%(5/12) respectively(P=0.515), and 180-day survival rate were 41.0%(5/12),25.0%(4/16)and 41.7%(5/12) respectively (P=0.606).No significant difference in survivors was observed between the three groups(P>0.05). There was none effects of gender on survival rates with application of Kaplan-Meier survival analysis of single factor analysis of gender lines(P>0.05). Further multivariate analysis, such as Cox proportional hazards model analysis, was conducted to adjust other baseline risk, which including the duration time of CRRT, CRRT dose and the filter life. The 28-day survival rate was significantly correlated with the CRRT dose (P<0.05), and the death of relative risk (RR) was 0.864(95% CI 0.770-0.969). The 90-day survival rate was no correlated with the three risk factors. There was correlation between 180-day survival rate and duration time of CRRT (RR=0.995,95% CI 0.990-1 .00) (P<0.05).The survivors for 28-day,90-day and 180-day in 42 patients were 22,15 and 14 respectively.The survivors with renal function recovery for 28-day, 90-day and 180-day were 81.8% (18/22),86.7% (13/15) and 85.7% (12/14) respectively. The survivors with renal function recovery for 28-day in the AKIN stage-1,2 and 3 groups were 85.7%, 87.5% and 71.4% respectively (P=0.810), and for 90-day were 83.3%,75.0% and 100%respectively (P=0.523), and for 180-day were 80.0%,75.0% and 100%respectively (P=0.511). There was no significant differences in the percentage of the survivors with renal function recovery among the three groups(P >0.05). Further multivariate analysis, such as Multivariate Logistic linear regression analysis, was conducted to adjust the other risk factors,which including gender, duration time of CRRT,CRRT dose and the filter life.There was no linear relationship between the and all risk factors.Conclusions:1 The survival rate for 28-day, 90-day and 180-day were no significantly difference among different AKIN stage in AKI patients treated with CRRT.2 The renal function recovery for 28-day, 90-day and 180-day were no significantly difference among different AKIN stage in AKI patients treated with CRRT. |
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