Continuous renal replacement therapy for the treatment of acute kidney injury

BACKGROUND/AIMS: Continuous renal replacement therapy (CRRT) has been widely used for treating critically ill patients with acute kidney injury (AKI). Whether CRRT is better than intermittent hemodialysis for the treatment of AKI remains controversial. We sought to identify the clinical features that can predict survival for the patients who are treated with CRRT. METHODS: We analyzed the data of 125 patients who received CRRT between 2005 and 2007. We identified the demographic variables, the underlying diagnoses, the duration of CRRT, the mean arterial blood pressure (ABP) and the Simplified Acute Physiology Score (SAPS) II. The classification/staging system for acute kidney injury (AKI) was applied to all the patients, who were then divided into stage 1-3 subgroups. RESULTS: The average age of the patients was 61.414.3 years and the mortality rate was 60% (75 of 125 patients). The survivors had a significantly higher mean ABP and a higher mean serum bicarbonate level, which were measured the day after CRRT, than the nonsurvivors (86.723.7 vs. 69.224.6 mm Hg, respectively, 21.43.5 vs. 16.45.4 mmol/L, respectively,; p<0.05 for each). The stage 3 AKI patients showed the worst parameters for the SAPS II score and the serum levels of creatinine and blood urea nitrogen. The mortality rate was higher for the stage 3 subgroup than the other groups (70.5%, p<0.05). CONCLUSIONS: The patients with AKI and who require CRRT continue to have a high mortality rate. A higher mean ABP and a higher serum bicarbonate level measured the day after CRRT may predict a more favorable prognosis. The staging system for AKI can improve the ability to predict the outcomes of CRRT patients.

Clinical Observation on Accidents for Infant and Childhood Who Visited the Emergency Room in the Wonju Christian Hospital from Kangwon Area

Accidents have become one of the most important problem in the pediatric and child health field because of the recently observed high incidence of and mortality from accidents. Due to an improvement of the living standard in general and especially due to the wide application of vaccination and antibiotics, there has been a decline of incidence of infectious diseases in childhood. However, in contrast accidents have occurred increasingly involving childhood recently. Many accidents have been recognized as being preventible. Therefore, parental health education should be emphasized as one of the more important preventive measures against accidents. This clinical study was carried out for analysis on 1,297 cases which were diagnosed as accidents at the emergency room in Wonju Christian Hospital during the 5 years, from Jan. 1, 1975 to Dec. 31, 1979. The results were as follows: 1. The most common type of accidents was traffic accidents which accounted for 393 cases(30.4%) of the total accidents, followed by falls(233 cases, 18.0%), burns(209 cases, 16.1%), trauma(199 cases, 15.3%), poisoning(126 cases, 9.7%), foreign body aspiration(42 cases, 3.4%), dog bites(30 cases, 2.3%), drowning and near drowning(24 cases, 1.6%). 2. An absolute number of accident patients increased in each year compared with the previous year. However, the child accident case found in the emergency room showed only 30% annually. 3. Traffic accidents and falls showed the highest incidence in children between 4 and 7 years. On the other hand, however, burn and foreign body aspiration showed the highest incidence between 2and 5 years. 4. Accidents were found more in males than females. Falls, drowning, near drowning, and snake bites were prodominantly in males. 5. Accidents were shown higher in summer and autumn and relatively lower in winter. 6. Sedans among all the various vehicles were the most common cause of traffic accidents (25.4%), followed by trucks(20.4%) and autobicycles(15.8%). 7. Falls occurred mostly at the play ground(13.3%), stairs(10.3%), roofs(8.6%) and trees(3.9%). 8. Scalding burns(64.8%) were the most common cause, followed by flame burns(13.3%) and coal briquet(3.9%). 9. In trauma, violence(24.1%) was the most common cause. Accidental injuries caused by farmer's tools(12.0%), hitting with stone(11.2%) and injury with pieces of glass(9.5%) followed in that order. 10. In poisoning, carbon monoxide intoxication and insecticides were the most common 26.2% in each, followed by D.D.S.(16.7%) and pestides(9.5%). 11. The most common material aspirated was coins(78.6%), followed by pins(95%) and buttons(4.7%). 12. 1,024 cases(78.9%) among 1,297 cases showed improvement. 65 cases(5.0%) expired and 64 cases(4.9%) had some complications.