Acute kidney injury in critical care: experience of a conservative strategy.
J Crit Care
; 29(6): 1022-7, 2014 Dec.
Article
in En
| MEDLINE
| ID: mdl-25123792
ABSTRACT
PURPOSE:
Renal replacement therapy (RRT) is a major supportive treatment of acute kidney injury (AKI) in intensive care unit (ICU), but the timing of its initiation remains open to debate. MATERIALS ANDMETHODS:
We retrospectively analyzed ICU patients who had AKI associated with at least one usual RRT criteria serum creatinine concentration greater than 300 µmol/L, serum urea concentration greater than 25 mmol/L, serum potassium concentration greater than 6.5 mmol/L, severe metabolic acidosis (arterial blood pH<7.2), oliguria (urine output<135 mL/8 hours or <400 mL/24 hours), overload pulmonary edema. To estimate the risk of death associated with RRT adjusted for risk factors, we performed a marginal structural Cox model with inverse-probability-of-treatment-weighted estimator.RESULTS:
Among 4173 patients admitted to the ICU, 203 patients fulfilled potential RRT criteria. Ninety-one patients (44.8%) received RRT and 112 (55.2%) did not. Non-RRT and RRT patients differed in terms of severity of illness Simplified Acute Physiology Score II (55±17 vs 60±19, respectively; P<.05) and Sequential Organ Failure Assessment score (8 [5-10] vs 9 [7-11], respectively; P=.01). Crude analysis indicated a lower ICU mortality for non-RRT compared with RRT patients (18% vs 45%; P<.001). In the marginal structural Cox model, RRT was associated with increased mortality (P<.01).CONCLUSION:
A conservative approach of AKI was not associated with increased mortality.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Renal Replacement Therapy
/
Acute Kidney Injury
Type of study:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
J Crit Care
Journal subject:
TERAPIA INTENSIVA
Year:
2014
Document type:
Article
Affiliation country:
France