RESUMEN
Background: Previous studies using Acute Kidney Injury Network [AKIN]/RIFLE criteria to classify early initiation of renal replacement therapy [RRT] have defined it as the therapy started in less severe AKIN/RIFLE stages. Generally, these studies failed in demonstrating measurable benefits
Aim: To evaluate RRT in critically ill patients and its timing and its impact on critically ill patients
Methods: We compared RRT initiation in critically ill patients and defined early or late RRT in reference to timing after stage 3 AKIN was met: patients beginning RRT within 24 hours after acute kidney injury [AKI] stage 3 were considered early starters. AKIN criteria were evaluated by both urine output [UO] and serum creatinine [sCr] and patients with acute-on-chronic kidney disease were excluded. A propensity score methodology was used to control variables
Results: A total of 358 critically ill patients were submitted to RRT. Only 150 patients with pure AKI at stage 3 were analyzed. Mortality was lower in the early RRT group [51.5 vs. 77.9%, P = 0.001]. After achieving balance between the groups using a propensity score, there was a significant 30.5 [95% confidence interval [CI] 14.4 to 45.2%, P = 0.002] relative decrease of mortality in the early RRT group. Moreover, patients on the early RRT group had lower duration of mechanical ventilation, time on RRT and a trend to lower intensive care unit [ICU] length of stay
Conclusions: For the first time, AKIN was used with UO criterion to evaluate early and late RRT. Using a time based approach could be a better parameter to access the association between RRT initiation and outcomes in patients with AKI