Clinical variables associated with poor outcome from sepsis-associated acute kidney injury and the relationship with timing of initiation of renal replacement therapy.

PURPOSE

Identify clinical variables associated with mortality in patients with sepsis-associated acute kidney injury (SA-AKI) receiving continuous renal replacement therapy (CRRT) and examine timing of initiation of CRRT in reference to those variables identified.

METHODS

Retrospective study conducted at two tertiary care hospitals including 939 septic shock patients with SA-AKI who received CRRT in the intensive care unit (ICU). Cox regression models were used to identify variables associated with 90-day mortality. Timing of CRRT initiation was assessed in relationship to significant clinical variables identified.

RESULTS

Overall 90-day mortality was 62.9%. Variables prior to CRRT associated with 90-day mortality included: age (aHR, 1.02; 95%CI, 1.01-1.02, p<000.1), APS-III score (1.01, 1.0-1.0, p<0.048), days from hospital admission to CRRT initiation (1.01, 1.0-1.0, p<0.01), blood urea nitrogen (1.01, 1.0-1.0, p<0.04), medical admission (1.76, 1.5-2.1, p<0.0001), creatinine (0.99, 0.9-1.0, p<0.001), and urine output (0.77, 0.6-0.9, p=0.049). In patients with advanced SA-AKI at ICU admission receiving CRRT within the first 5days (n=433), urine output during the 24h prior to CRRT initiation was a strong predictor of survival (2.6, 1.6-4.3, p<0.001).

CONCLUSIONS

In patients with SA-AKI, survival is lower when CRRT is started in the setting of low urine output.