Clinical Features and Adequate Indication of CRRT in Severely Burned Patients

ABSTRACT

PURPOSE: Acute renal failure is not a rare event in severe burns and the prognosis of a burn patient becomes remarkably unfavorable with the onset of renal insufficiency. Several studies have reported that the incidence of ARF in severe burns is 0.5 ~ 30% and the mortality rate is 73 ~ 90%. This study analyzed the clinical features of severe burns requiring continuous renal replacement therapy (CRRT) to determine the adequate indication for CRRT. METHODS: Thirty-nine patients requiring CRRT out of 492 burned patients who were admitted to the burn intensive care unit in the Burn center, Hangang Sacred Heart Hospital from January 2003 to December 2004, were reviewed. CRRT was indicated when azotemia, fluid overload, acidosis, or hyperkalemia were observed. The APACHE II score, BUN, creatinine, creatine kinase, bicarbonate and base excess were analyzed at admission and at the initiation of CRRT for the survival group and non-survival group. RESULTS: The incidence of ARF requiring CRRT in severely burned patients was 7.9%. The average of burn area was 51.1%. The mean delay in initiating CRRT was 16.6 days and the mean duration of CRRT was 7.0 days. There was no difference between the survival group and the non- survival group in the data obtained upon admission, but there was a significant difference in the BUN level at the initiation CRRT. Therefore, the BUN level at the initiation CRRT has corelation with the mortality. CONCLUSION: CRRT is helpful for treating severely burned patients who have ARF, particularly those with accompanying with hemodynamic instability. This study showed that the BUN level at the initiation of CRRT associated with mortality. Therefore, the BUN level is an important criterion for initiating CRRT in these patients. However, a prospective randomized control study will be needed to accurately define BUN level.