Early continuous renal replacement therapy in septic acute kidney injury could be defined by its initiation within 24 hours of vasopressor infusion

Abstract

Purpose: The optimal timing for the initiation of early continuous renal replacement therapy (CRRT) is uncertain and requires a practically feasible definition with acceptable evidence.

Materials and methods: We investigated the clinical impacts of 3-time interval parameters on the morbidity and mortality of 177 patients with septic shock-induced acute kidney injury: (1) time from vasopressor initiation to CRRT initiation (T_vaso-CRRT), (2) time from intensive care unit (ICU) admission to CRRT initation (T_ICU-CRRT), and (3) time from endotracheal intubation to CRRT initiation (T_endo-CRRT).

Results: The proportion of the patients with T_vaso-CRRT less than 24 h (median, 14 h, interquartile range [IQR], 5-30 h) was significantly higher in the survival group than in the non-survival group (84.3% vs. 58.5%, p < 0.001). T_vaso-CRRT less than 24 h and Sequential Organ Failure Assessment score were independent factors associated with 28-day mortality and 90-day mortality. T_ICU-CRRT (median, 17 h, IQR, 5-72 h) and T_endo-CRRT (median, 13 h, IQR, 4-48 h) were significantly correlated with both the length of ICU stay (p < 0.001) and mechanical ventilation duration (p < 0.001), but not mortality.

Conclusions: Considering the possible therapeutic measurement by physician on the basis of the results in this study, early CRRT could be defined by a T_vaso-CRRT less than 24 h.

Keywords: Critical care; Mortality; Renal function; Renal replacement therapy.