Current state of continuous renal replacement therapy for acute kidney injury in Japanese intensive care units in 2011: analysis of a national administrative database.

Nationwide data for the prevalence and outcomes of patients receiving continuous renal replacement therapy (CRRT) in intensive care units (ICUs) are scarce. This study assessed the status of CRRT in Japanese ICUs using a nationwide administrative claim database. Data were extracted from the Japanese Diagnosis Procedure Combination database for 2011. From a cohort of critically ill patients aged 12 years or older who were admitted to ICUs for 3 days or longer, acute kidney injury (AKI) patients treated with CRRT were identified. The period prevalence of CRRT and in-hospital mortality were calculated. Logistic regression analysis identified factors associated with in-hospital mortality. Of 165 815 ICU patients, 6478 (3.9%) received CRRT for AKI. The most frequent admission diagnosis category was diseases of the circulatory system (n = 3074). The overall in-hospital mortality rate of the CRRT-treated AKI patients was 50.6%. Clustering patients into four groups by background revealed the lowest in-hospital mortality rate of 41.5% for the cardiovascular surgery group (n = 1043) compared with 53.5% for the nonsurgical cardiovascular group (n = 2031), 51.7% for the sepsis group (n = 1863) and 51.6% for other cases (n = 1541). Multiple logistic regression analysis showed a significant association of these four group classifications with in-hospital mortality in addition to age, hospital characteristics (type and volume), time from hospital admission to CRRT initiation and interventions performed on the day of CRRT initiation. Using a large Japanese nationwide database, this study revealed remarkably high in-hospital mortality of CRRT-treated AKI patients, although the period prevalence of CRRT for AKI in ICUs was low.

Iwagami M ，Yasunaga H ，Noiri E ，Horiguchi H ，Fushimi K ，Matsubara T ，Yahagi N ，Nangaku M ，Doi K ... -  《-》

Sepsis may not be a risk factor for mortality in patients with acute kidney injury treated with continuous renal replacement therapy.

Nagata I ，Uchino S ，Tokuhira N ，Ohnuma T ，Namba Y ，Katayama S ，Kawarazaki H ，Toki N ，Takeda K ，Yasuda H ，Izawa J ，Uji M ，JSEPTIC (Japanese Society for Physicians Trainees in Intensive Care) Clinical Trial Group ... -  《-》

[Effect of early initiation of continuous renal replacement therapy based on the KDIGO classification on the prognosis of critically ill patients with acute kidney injury].

Chen M ，Hu B ，Li Q ，Liu J ... -  《-》

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

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

Pérez-Fernández X ，Sabater-Riera J ，Sileanu FE ，Vázquez-Reverón J ，Ballús-Noguera J ，Cárdenas-Campos P ，Betbesé-Roig A ，Kellum JA ... -  《-》

Red blood cell distribution width is an independent predictor of mortality in acute kidney injury patients treated with continuous renal replacement therapy.

Oh HJ ，Park JT ，Kim JK ，Yoo DE ，Kim SJ ，Han SH ，Kang SW ，Choi KH ，Yoo TH ... -  《-》