Paper - WANFANG MED ONLINE

You Position: Home > Paper

Early initiation renal replacement therapy for fluid management to reduce central venous pressure is more conducive to renal function recovery in patients with acute kidney injury

( views:18, downloads:4 )

Author:: No author available

Journal Title:: Chinese Medical Journal

Issue:: 11

DOI:: 10.1097/CM9.0000000000000240

Key Word:: Sepsis;Acute kidney injury;Renal replacement therapy;Central venous pressure

Abstract： Background:Acute kidney injury (AKI) is a serious complication in critically ill patients with septic shock treated in the intensive care unit.Renal replacement therapy (RRT) is a treatment for severe AKI;however,the time of initiation of RRT and factors that affect the recovery of kidney function remains unclear.This study was to explore whether early initiation of RRT treatment for fluid management to reduce central venous pressure (CVP) can help to improve patients' kidney function recovery.Methods:A retrospective analysis of septic patients who had received RRT treatment was conducted.Patients received RRT either within 12 h after they met the diagnostic criteria of renal failure (early initiation) or after a delay of 48 h if renal recovery had not occurred (delayed initiation).Parameters such as patients' renal function recovery at discharge,fluid balance,and levels of CVP were assessed.Results:A total of 141 patients were eligible for enrolment:40.4％ of the patients were in the early initiation group (57 of 141 patients),and 59.6％ were in the delayed initiation group (84 of 141 patients).There were no significant differences in the characteristics at baseline between the two groups,and there were no differences in 28-day mortality between the two groups (x 2=2.142,P =0.143);however,there was a significant difference in the recovery rate of renal function between the two groups at discharge (x2 =4.730,P ＜ 0.001).More importantly,early initiation of RRT treatment and dehydration to reduce CVP are more conducive to the recovery of renal function in patients with AKI.Conclusion:Compared with those who received delayed initiation RRT,patients who received early-initiation RRT for dehydration to reduce CVP have enhanced kidney function recovery.

Reference

[1]Chan-Yu Lin,Yung-Chang Chen.Acute kidney injury classification: AKIN and RIFLE criteria in critical patients[J].2012,(2).
[2]Jean-Pierre Quenot,Christine Binquet,Fady Kara,etc.The epidemiology of septic shock in French intensive care units: the prospective multicenter cohort EPISS study[J].2013,17.
[3]Levin,A.,Stevens,P.E..Evaluation and management of chronic kidney disease: Synopsis of the kidney disease: Improving global outcomes 2012 clinical practice guideline[J].2013,158(11).
[4]Claudio, Ronco,Zaccaria, Ricci,Daniel, De Backer,etc.Renal replacement therapy in acute kidney injury: controversy and consensus.[J].2015,19.
[5]Neyra, Javier A.,Li, Xilong,Canepa-Escaro, Fabrizio,etc.Cumulative Fluid Balance and Mortality in Septic Patients With or Without Acute Kidney Injury and Chronic Kidney Disease[J].2016,44(10).
[6]Bellomo, Rinaldo,Kellum, John A.,Ronco, Claudio,etc.Acute kidney injury in sepsis[J].2017,43(6).
[7]Constantine J Karvellas,Maha R Farhat,Imran Sajjad,etc.A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis[J].2011,15(1).
[8]Voors AA,Damman K,van-Veldhuisen DJ,etc.Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease.[J].2009,53(7).
[9]Abrahams Z,Taylor DO,Sokos G,etc.Importance of venous congestion for worsening of renal function in advanced decompensated heart failure.[J].2009,53(7).
[10]Stéphane, Gaudry,David, Hajage,Fréderique, Schortgen,etc.Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit.[J].2016.
[11]Namkje Ar, Vellinga,Can, Ince,E Christiaan, Boerma.Elevated central venous pressure is associated with impairment of microcirculatory blood flow in sepsis: a hypothesis generating post hoc analysis.[J].2013,13.
[12]Barbar, S. D.,Clere-Jehl, R.,Bourredjem, A.,etc.Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis[J].2018,379(15).
[13]Ryota, Sato,Sarah Kyuragi, Luthe,Michitaka, Nasu.Blood pressure and acute kidney injury.[J].2017,21(1).
[14]Soo Young, Kim,Ye Na, Kim,Ho Sik, Shin,etc.The influence of hypophosphatemia on outcomes of low- and high-intensity continuous renal replacement therapy in critically ill patients with acute kidney injury.[J].2017,36(3).
[15]Wong, Benjamin T.,Chan, Matthew J.,Glassford, Neil J.,etc.Mean arterial pressure and mean perfusion pressure deficit in septic acute kidney injury[J].2015,30(5).
[16]D.V. Pilcher,C.D. Scheinkestel,G.I. Snell,etc.High central venous pressure is associated with prolonged mechanical ventilation and increased mortality after lung transplantation[J].2005,129(4).
[17]Kellum, John A.,Boanta, Andreea,Meersch, Melanie,etc.Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients With Acute Kidney Injury The ELAIN Randomized Clinical Trial[J].2016,315(20).
[18]Yu-Hsiang Chou,Tao-Min Huang,Vin-Cent Wu,etc.Impact of timing of renal replacement therapy initiation on outcome of septic acute kidney injury[J].2011,15(3).
[19]Chawla, Lakhmir S.,Bellomo, Rinaldo,Bihorac, Azra,etc.Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup[J].2017,13(4).
[20]Wald, Ron,Bagshaw, Sean M..The Timing of Renal Replacement Therapy Initiation in Acute Kidney Injury: Is Earlier Truly Better?[J].2014,42(8).
[21]Christophe, Vinsonneau,Christophe, Camus,Alain, Combes,etc.Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial.[J].2006,368.
[22]Forni, L. G.,Darmon, M.,Ostermann, M.,etc.Renal recovery after acute kidney injury[J].2017,43(6).
[23]Scott DJ,Mandelbaum T,Malhotra A,etc.Outcome of critically ill patients with acute kidney injury using the Acute Kidney Injury Network criteria.[J].2011,39(12).
[24]Chen, Kenneth P.,Lee, Joon,Peng, Mengling,etc.Peripheral Edema, Central Venous Pressure, and Risk of AKI in Critical Illness[J].2016,11(4).
[25]Michael, Heung,Diane E, Steffick,Kara, Zivin,etc.Acute Kidney Injury Recovery Pattern and Subsequent Risk of CKD: An Analysis of Veterans Health Administration Data.[J].2016,(5).
[26]Claudio, Ronco,John A, Kellum,Michael, Haase.Subclinical AKI is still AKI.[J].2012,16(3).
[27]Hoste, E. A.,Kellum, J. A.,Katz, N. M.,etc.Epidemiology of Acute Kidney Injury[J].2010,165(1).
[28]Mauro, Neri,Gianluca, Villa,Francesco, Garzotto,etc.Nomenclature for renal replacement therapy in acute kidney injury: basic principles.[J].2016,(1).
[29]Matthieu, Legrand,Claire, Dupuis,Christelle, Simon,etc.Association between systemic hemodynamics and septic acute kidney injury in critically ill patients: a retrospective observational study.[J].2013,17(6).
[30]Cendoroglo M,Sosa MA,Jaber BL,etc.Timing of renal replacement therapy initiation in acute renal failure: a meta-analysis.[J].2008,52(2).
[31]Morgera S,Schetz M,Bouman C,etc.Acute renal failure in critically ill patients: a multinational, multicenter study.[J].2005,294(7).
[32]Kellum, John A.,Sileanu, Florentine E.,Bihorac, Azra,etc.Recovery after Acute Kidney Injury[J].2017,195(6).
[33]Ross,E.A..Congestive renal failure: The pathophysiology and treatment of renal venous hypertension[J].2012,18(12).
[34]F, Garzotto,M, Ostermann,D, Martín-Langerwerf,etc.The Dose Response Multicentre Investigation on Fluid Assessment (DoReMIFA) in critically ill patients.[J].2016,(1).
[35]Noel, Gibney,Eric, Hoste,Emmanuel A, Burdmann,etc.Timing of initiation and discontinuation of renal replacement therapy in AKI: unanswered key questions.[J].2008,3(3).