%0 Journal Article
%T Impact of timing of renal replacement therapy initiation on outcome of septic acute kidney injury
%A Yu-Hsiang Chou
%A Tao-Min Huang
%A Vin-Cent Wu
%A Cheng-Yi Wang
%A Chih-Chung Shiao
%A Chun-Fu Lai
%A Hung-Bin Tsai
%A Chia-Ter Chao
%A Guang-Huar Young
%A Wei-Jei Wang
%A Tze-Wah Kao
%A Shuei-Liong Lin
%A Yin-Yi Han
%A Anne Chou
%A Tzu-Hsin Lin
%A Ya-Wen Yang
%A Yung-Ming Chen
%A Pi-Ru Tsai
%A Yu-Feng Lin
%A Jenq-Wen Huang
%A Wen-Chih Chiang
%A Nai-Kuan Chou
%A Wen-Je Ko
%A Kwan-Dun Wu
%A Tun-Jun Tsai
%A the NSARF Study Group
%J Critical Care
%D 2011
%I BioMed Central
%R 10.1186/cc10252
%X Patient with sepsis and AKI requiring RRT in surgical intensive care units were enrolled between January 2002 and October 2009. The patients were divided into early (sRIFLE-0 or -Risk) or late (sRIFLE-Injury or -Failure) initiation of RRT by sRIFLE criteria. Cox proportional hazard ratios for in hospital mortality were determined to assess the impact of timing of RRT.Among the 370 patients, 192 (51.9%) underwent early RRT and 259 (70.0%) died during hospitalization. The mortality rate in early and late RRT groups were 70.8% and 69.7% respectively (P > 0.05). Early dialysis did not relate to hospital mortality by Cox proportional hazard model (P > 0.05). Patients with heart failure, male gender, higher admission creatinine, and operation were more likely to be in the late RRT group. Cox proportional hazard model, after adjustment with propensity score including all patients based on the probability of late RRT, showed early dialysis was not related to hospital mortality. Further model matched patients by 1:1 fashion according to each patient's propensity to late RRT showed no differences in hospital mortality according to head-to-head comparison of demographic data (P > 0.05).Use of sRIFLE classification as a marker poorly predicted the benefits of early or late RRT in the context of septic AKI. In the future, more physiologically meaningful markers with which to determine the optimal timing of RRT initiation should be identified.Acute kidney injury (AKI) is a common entity in critically ill patients with an incidence of about 30 to 60% [1] as defined by the RIFLE (risk, injury, failure, loss of kidney function, and end-stage renal failure) classification and is thought to be an independent risk factor for increased morbidity and mortality [2-4]. Sepsis is the leading cause of AKI, contributing to 30 to 50% of cases of AKI [4,5]. Almost 30% of septic AKI patients need renal replacement therapy (RRT). This rate is much higher than that observed for other causes of AKI
%U http://ccforum.com/content/15/3/R134