Leite Tacyano T, Macedo Etienne, Pereira Samuel M, Bandeira Sandro R C, Pontes Pedro H S, Garcia André S, Militão Fernanda R, Sobrinho Irineu M M, Assunção Livia M, Libório Alexandre B
Crit Care. 2013 Apr 2;17(2):R62. doi: 10.1186/cc12593.
Previous studies using Acute Kidney Injury Network (AKIN)/RIFLE criteria to classify early initiation of renal replacement therapy (RRT) have defined it as the therapy started in less severe AKIN/RIFLE stages. Generally, these studies failed in demonstrating measurable benefits.
We compared RRT initiation in critically ill patients and defined early or late RRT in reference to timing after stage 3 AKIN was met: patients beginning RRT within 24 hours after acute kidney injury (AKI) stage 3 were considered early starters. AKIN criteria were evaluated by both urine output (UO) and serum creatinine (sCr) and patients with acute-on-chronic kidney disease were excluded. A propensity score methodology was used to control variables.
A total of 358 critically ill patients were submitted to RRT. Only 150 patients with pure AKI at stage 3 were analyzed. Mortality was lower in the early RRT group (51.5 vs. 77.9%, P=0.001). After achieving balance between the groups using a propensity score, there was a significant 30.5 (95% confidence interval [CI] 14.4 to 45.2%, P=0.002) relative decrease of mortality in the early RRT group. Moreover, patients on the early RRT group had lower duration of mechanical ventilation, time on RRT and a trend to lower intensive care unit (ICU) length of stay.
For the first time, AKIN was used with UO criterion to evaluate early and late RRT. Using a time-based approach could be a better parameter to access the association between RRT initiation and outcomes in patients with AKI.
以往使用急性肾损伤网络（AKIN）/RIFLE标准对早期开始肾脏替代治疗（RRT）进行分类的研究将其定义为在病情较轻的AKIN/RIFLE阶段开始的治疗。一般来说，这些研究未能证明有可衡量的益处。
我们比较了危重症患者开始RRT的情况，并根据达到AKIN 3期后的时间来定义早期或晚期RRT：急性肾损伤（AKI）3期后24小时内开始RRT的患者被视为早期开始者。通过尿量（UO）和血清肌酐（sCr）评估AKIN标准，并排除急性慢性肾病患者。采用倾向评分方法来控制变量。
共有358例危重症患者接受了RRT。仅分析了150例3期单纯AKI患者。早期RRT组的死亡率较低（51.5%对77.9%，P = 0.001）。使用倾向评分使两组达到平衡后，早期RRT组的死亡率相对显著降低了30.5%（95%置信区间[CI] 14.4%至45.2%，P = 0.002）。此外，早期RRT组患者的机械通气时间、RRT时间较短，且在重症监护病房（ICU）的住院时间有缩短趋势。
首次将AKIN与UO标准结合用于评估早期和晚期RRT。采用基于时间的方法可能是评估AKI患者RRT开始与预后之间关联的更好参数。
