Background The optimal timing to start continuous renal replacement therapy （CRRT） for acute kidney injury （AKI） patients has not been accurately established. The recently proposed risk, injury, failure, loss, end...Background The optimal timing to start continuous renal replacement therapy （CRRT） for acute kidney injury （AKI） patients has not been accurately established. The recently proposed risk, injury, failure, loss, end-stage kidney disease （RIFLE） criteria for diagnosis and classification of AKI may provide a method for clinicians to decide the ＂optimal timing＂ for starting CRRT under uniform guidelines. The present study aimed： （1） to analyze the correlation between RIFLE stage at the start of CRRT and 90-day survival rate after CRRT start, （2） to further investigate the correlation of RIFLE stage with the malignant kidney outcome in the 90-day survivors, and （3） to determine the influence of the timing of CRRT defined by RIFLE classification on the 90-day survival and malignant kidney outcome in 90-day survivors.Methods A retrospective cohort analysis was performed on the data of 106 critically ill patients with AKI, treated with CRRT during a 6-year period in a university affiliated surgical intensive care unit （SICU）. Information such as sex, age, RIFLE stage, sepsis, sepsis-related organ failure assessment （SOFA） score, number of organ failures before CRRT, CRRT time during SICU, survival, and kidney outcome conditions at 90 days after CRRT start was collected. According to their baseline severity of AKI at the start of CRRT, the patients were assigned to three groups according to the increasing severity of RIFLE stages： RIFLE-R （risk of renal dysfunction, R）, RIFLE-I （injury to the kidney, I） and RIFLE-F （failure of kidney function, F） using RIFLE criteria. The malignant kidney outcome was classified as RIFLE-L （loss of kidney function L） or RIFLE-E （end-stage kidney disease, E） using RIFLE criteria. The correlation between RIFLE stage and 90-day survival rate was analyzed among these three RIFLE-categorized groups. Additionally, the association between RIFLE stage and the malignant kidney outcome （RIFLE-L＋RIFLF-E） in the 90-day survivors was anal展开更多
Acute kidney injury(AKI) is a frequent clinical event in patients with liver disease, compounding their prognosis. Furthermore, it is likely that the occurrence of AKI has a detrimental impact on the subsequent renal ...Acute kidney injury(AKI) is a frequent clinical event in patients with liver disease, compounding their prognosis. Furthermore, it is likely that the occurrence of AKI has a detrimental impact on the subsequent renal function and the long-term survival of these patients. Recently, some authors advocated the use of new diagnostic criteria for detecting acute kidney injury in patients with cirrhosis. These criteria are based on the rapidity and extent of the creatinine increase comparing to the basal creatinine and also on the kinetics of diuresis decrease. Although their validity in this population requires further studies to be clearly established, these new criteria could have two advantages:(1) to allow earlier diagnosis of AKI and, thus, hepatorenal syndromefor which earlier intervention could improve patients' survival; and(2) to promote more intensive monitoring of renal function in these patients with high risk of AKI. Finally, recent practice guidelines about the prevention and treatment of general AKI have been published which should be useful in optimising the management of AKI in cirrhotic patients.展开更多
文摘Background The optimal timing to start continuous renal replacement therapy （CRRT） for acute kidney injury （AKI） patients has not been accurately established. The recently proposed risk, injury, failure, loss, end-stage kidney disease （RIFLE） criteria for diagnosis and classification of AKI may provide a method for clinicians to decide the ＂optimal timing＂ for starting CRRT under uniform guidelines. The present study aimed： （1） to analyze the correlation between RIFLE stage at the start of CRRT and 90-day survival rate after CRRT start, （2） to further investigate the correlation of RIFLE stage with the malignant kidney outcome in the 90-day survivors, and （3） to determine the influence of the timing of CRRT defined by RIFLE classification on the 90-day survival and malignant kidney outcome in 90-day survivors.Methods A retrospective cohort analysis was performed on the data of 106 critically ill patients with AKI, treated with CRRT during a 6-year period in a university affiliated surgical intensive care unit （SICU）. Information such as sex, age, RIFLE stage, sepsis, sepsis-related organ failure assessment （SOFA） score, number of organ failures before CRRT, CRRT time during SICU, survival, and kidney outcome conditions at 90 days after CRRT start was collected. According to their baseline severity of AKI at the start of CRRT, the patients were assigned to three groups according to the increasing severity of RIFLE stages： RIFLE-R （risk of renal dysfunction, R）, RIFLE-I （injury to the kidney, I） and RIFLE-F （failure of kidney function, F） using RIFLE criteria. The malignant kidney outcome was classified as RIFLE-L （loss of kidney function L） or RIFLE-E （end-stage kidney disease, E） using RIFLE criteria. The correlation between RIFLE stage and 90-day survival rate was analyzed among these three RIFLE-categorized groups. Additionally, the association between RIFLE stage and the malignant kidney outcome （RIFLE-L＋RIFLF-E） in the 90-day survivors was anal
文摘Acute kidney injury(AKI) is a frequent clinical event in patients with liver disease, compounding their prognosis. Furthermore, it is likely that the occurrence of AKI has a detrimental impact on the subsequent renal function and the long-term survival of these patients. Recently, some authors advocated the use of new diagnostic criteria for detecting acute kidney injury in patients with cirrhosis. These criteria are based on the rapidity and extent of the creatinine increase comparing to the basal creatinine and also on the kinetics of diuresis decrease. Although their validity in this population requires further studies to be clearly established, these new criteria could have two advantages:(1) to allow earlier diagnosis of AKI and, thus, hepatorenal syndromefor which earlier intervention could improve patients' survival; and(2) to promote more intensive monitoring of renal function in these patients with high risk of AKI. Finally, recent practice guidelines about the prevention and treatment of general AKI have been published which should be useful in optimising the management of AKI in cirrhotic patients.
