Research

Late initiation of renal replacement therapy is associated with worse outcomes in acute kidney injury after major abdominal surgery

Chih-Chung Shiao¹ , Vin-Cent Wu² , Wen-Yi Li³ , Yu-Feng Lin² , Fu-Chang Hu⁴ , Guang-Huar Young⁵ , Chin-Chi Kuo³ , Tze-Wah Kao² , Down-Ming Huang³ , Yung-Ming Chen² , Pi-Ru Tsai⁵ , Shuei-Liong Lin² , Nai-Kuan Chou⁵ , Tzu-Hsin Lin⁵ , Yu-Chang Yeh⁶ , Chih-Hsien Wang⁵ , Anne Chou⁶ , Wen-Je Ko⁵ and Kwan-Dun Wu² for the National Taiwan University Surgical Intensive Care Unit-Associated Renal Failure (NSARF) Study Group

¹  Division of Nephrology, Department of Internal Medicine, Saint Mary's Hospital, 160 Chong-Cheng South Road, Lotung 265, I-Lan, Taiwan

²  Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, Taiwan

³  Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd., Douliu City, Yunlin County 640, Taiwan

⁴  National Center of Excellence for General Clinical Trial and Research, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, Taiwan

⁵  Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, Taiwan

⁶  Department of Anesthesiology, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, Taiwan

author email corresponding author email

Critical Care 2009, 13:R171doi:10.1186/cc8147

Published:	30 October 2009

See related commentary by Macedo and Mehta, http://ccforum.com/content/14/1/112

Abstract

Introduction

Abdominal surgery is probably associated with more likelihood to cause acute kidney injury (AKI). The aim of this study was to evaluate whether early or late start of renal replacement therapy (RRT) defined by simplified RIFLE (sRIFLE) classification in AKI patients after major abdominal surgery will affect outcome.

Methods

A multicenter prospective observational study based on the NSARF (National Taiwan University Surgical ICU Associated Renal Failure) Study Group database. 98 patients (41 female, mean age 66.4 ± 13.9 years) who underwent acute RRT according to local indications for post-major abdominal surgery AKI between 1 January, 2002 and 31 December, 2005 were enrolled The demographic data, comorbid diseases, types of surgery and RRT, as well as the indications for RRT were documented. The patients were divided into early dialysis (sRIFLE-0 or Risk) and late dialysis (LD, sRIFLE -Injury or Failure) groups. Then we measured and recorded patients' outcome including in-hospital mortality and RRT wean-off until 30 June, 2006.

Results

The in-hospital mortality was compared as endpoint. Fifty-seven patients (58.2%) died during hospitalization. LD (hazard ratio (HR) 1.846; P = 0.027), old age (HR 2.090; P = 0.010), cardiac failure (HR 4.620; P < 0.001), pre-RRT SOFA score (HR 1.152; P < 0.001) were independent indicators for in-hospital mortality.

Conclusions

The findings of this study support earlier initiation of acute RRT, and also underscore the importance of predicting prognoses of major abdominal surgical patients with AKI by using RIFLE classification.