Early vs. late initiation of continuous renal replacement therapy in patient suffering from septic shock and acute renal failure

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Acute kidney injury (AKI) affects 5% to 7% of all hospitalized patients (1-2). Sepsis and septic shock remain the most important cause of AKI in critically ill patients and account for more than 50% of cases of AKI in the intensive care unit (3). The optimal timing for initiation of renal replacement therapy (RRT) in septic AKI remains controversial. The main reason is the absence of a clear and consensual definition of AKI to stratify patients according to the degree of renal impairment. The development of new system, like Risk, Injury, Failure , Loss of kidney function, and End -stage renal failure (RIFLE) classification represent a major step forward (4). Recent meta-analysis showed that earlier initiation of RRT in AKI may have a beneficial impact on survival (5). However, the conclusion is based on heterogeneous studies of variable quality. Moreover, the causes of AKI differ between studies, with less than half of the included cases were due to sepsis. In fact, the author concluded that a definitive treatment recommendation on timing of RRT in AKI cannot be made. The aim of this study is to investigate the impact of early versus late initiation of continuous renal replacement therapy (CRRT) as defined by using the simplified RIFLE classification, on organ dysfunction among patients with septic shock and AKI. We hypotheized that early CRRT in septic shock can decrease organ dysfunction. Medical records of those patient who were admited into our intensive care unit from 2008 to 2011 and required CRRT support are reviewed. Those fulfiled the inclusion criteria and without exclusion criteria are recruited for further data analyisis. 1. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005 Aug 17;294(7):813-8. 2. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002 May;39(5):930-6. 3. Silvester W, Bellomo R, Cole L. Epidemiology, management, and outcome of severe acute renal failure of critical illness in Australia. Crit Care Med. 2001 Oct;29(10):1910-5. 4. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004 Aug;8(4):R204-12. 5. Karvellas CJ, Farhat MR, Sajjad I, Mogensen SS, Leung AA, Wald R, et al. A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis. Crit Care. 2011;15(1):R72.

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