Clinical Study On The Timing Of CRRT For Patients With Septic Acute Kidney Injury

Objective:Evaluate the influence of CRRT to prognosis of patients with sepsis induced AKI at early stage of AKI, and to explore the timing of CRRT for patients with septic acute kidney injury.Methods:A retrospective analysis was performed on the data of160critically ill patients with septic AKI, in Binzhou medical college affiliated hospital intensive care unit from January2009to December2011. According to the AKIN criteria, patients were divided into three groups:stage1group, stage2group and stage3group, every group was further divided into CRRT group and control group (without CRRT). Firstly, We compared the28-days mortality in two group of every stage, secondly, we compared ICU stay, mechanical ventilation time and SOFA value between CRRT group and control group of each stage. Except that, we compared renal recover rate between CRRT group and control group of each stage, and renal function deterioration between CRRT group and control group in AKI stage1and stage2. Univariate and multivariate logistic regression analyses were performed to determine the most significant risk factors for28-days-mortality and renal recovery.Results:200patients were chosen in this study, of these,5patients were eliminated because of combining with Chronic kidney disease,14patients were eliminated because of the time of CRRT being less than24hours,21patient were eliminated because of ICU stay being less than72hours(the main reasons were that giving up treatment, turn courtyard and cardiovascular accident). At last,160patients met the inclusion criteria, of whom84patients (52.5%) died. The median survival time from admission was14.6days [95%confidence interval (CI)13.0,16.3]. Renal recovery, defined as independence from dialysis at discharge, was documented for64/76(84.2%) of the surviving patients (48.1%of total subjects included in the study). The mortality rate increased proportionally with AKIN stages, with CRRT (P=0.001), without (P=0.029). Poor outcomes were found in control group compared with CRRT group in stage2of AKI (P=0.125, stage1; P=0.048, stage2; P=0.310, stage3). ICU-stay (P=0.045) and mechanical ventilation time(0.050) were shorter in CRRT group of AKI2, compared with control group. SOFA scores of CRRT group was decreasing gradually(all P<0.05). The renal function progress rate was17.4%and58.3%in CRRT group and control group in stagelof AKI, showing significant difference (P=0.002), and the progress rate of stage2was different in statistics (30.3%in CRRT group,59.3%in control group, P=0.031). Important factors that significantly increased mortality included absence of renal recovery (P<0.001), urine output of first day≤500ml (P=0.034) and APACHE II scores≥20(P=0.047).Bacteria (P=0.022) and urine output of the second day≤500ml (P=0.005) correlated significantly with renal recovery.Conclusions:1. The results of study supported that stage2of AKI may be the optimal timing for starting CRRT.2. Important factors that significantly increased mortality included absence of renal recovery, urine output of first day≤500ml and APACHE II scores≥20. Bacteria and urine output of the second day≤500ml correlated significantly with renal recovery.