Division of Nephrology, Department of Internal Medicine, Saint Mary's Hospital, 160 Chong-Cheng South Road, Lotung 265, I-Lan, Taiwan.
Crit Care. 2009;13(5):R171. doi: 10.1186/cc8147. Epub 2009 Oct 30.
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.
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.
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.
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.
腹部手术可能更有可能导致急性肾损伤（AKI）。本研究的目的是评估主要腹部手术后 AKI 患者根据简化 RIFLE（sRIFLE）分类定义的早期或晚期开始肾脏替代治疗（RRT）是否会影响结局。
基于 NSARF（台湾大学外科重症监护室相关肾衰竭）研究组数据库的多中心前瞻性观察性研究。2002 年 1 月 1 日至 2005 年 12 月 31 日，根据局部适应证对 98 例接受急性 RRT 的患者（41 例女性，平均年龄 66.4±13.9 岁）进行了研究。记录了人口统计学数据、合并症、手术类型和 RRT，以及 RRT 的适应证。患者分为早期透析（sRIFLE-0 或风险）和晚期透析（LD，sRIFLE-损伤或衰竭）组。然后测量并记录患者的预后，包括住院期间死亡率和直至 2006 年 6 月 30 日的 RRT 撤机情况。
将住院期间死亡率作为终点进行比较。57 例患者（58.2%）在住院期间死亡。LD（风险比（HR）1.846；P=0.027）、高龄（HR 2.090；P=0.010）、心力衰竭（HR 4.620；P<0.001）、RRT 前 SOFA 评分（HR 1.152；P<0.001）是住院期间死亡率的独立指标。
本研究的结果支持早期开始急性 RRT，并且还强调了使用 RIFLE 分类预测 AKI 主要腹部手术患者预后的重要性。
