Too early initiation of renal replacement therapy may be harmful

Christophe Vinsonneau, Mehran Monchi, Christophe Vinsonneau, Mehran Monchi

Abstract

In an observational multicenter study, Elseviers and colleagues report that renal replacement therapy (RRT) in acutely ill patients treated for acute kidney injury is an independent risk factor for death. This result may question the benefit of the current practice of early RRT initiation.

References

    1. Elseviers MM, Lins RL, Van der Niepen P, Hoste E, Malbrain ML, Damas P, Devriendt J. (SHARF) Investigators SHARF. Renal replacement therapy is an independent risk factor for mortality in critically ill patients with acute kidney injury. Crit Care. 2010;14:R221. doi: 10.1186/cc9355.
    1. Joannidis M, Metnitz B, Bauer P, Schusterschitz N, Moreno R, Druml W, Metnitz PG. Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3database. Intensive Care Med. 2009;35:1692–1702. doi: 10.1007/s00134-009-1530-4.
    1. Coca SG, Peixoto AJ, Garg AX, Krumholz H, Parikh CR. The prognostic importance of a small acute decrement in kidney function in hospitalized patients: a systematic review and meta-analysis. Am J Kidney Dis. 2007;50:712–720. doi: 10.1053/j.ajkd.2007.07.018.
    1. Metnitz PG, Krenn CG, Steltzer H, Lang T, Ploder J, Lenz K, Le Gall JR, Druml W. Effects of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med. 2002;30:2051–2058. doi: 10.1097/00003246-200209000-00016.
    1. Guerin C, Girard R, Selli JM, Perdrix JP, Ayzac L. Initial versus delayed acute renal failure in the intensive care unit. Am J Respir Crit Care Med. 2000;161:872–879.
    1. Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Oudemans-van Straaten H, Ronco C, Kellum JA. Continuous renal replacement therapy: a worldwide practice survey. The beginning and ending supportive therapy for the kidney (B.E.S.T. kidney) investigators. Intensive Care Med. 2007;33:1563–1570. doi: 10.1007/s00134-007-0754-4.
    1. RENAL Replacement Therapy Study Investigators. Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lo S, McArthur C, McGuinness S, Myburgh J, Norton R, Scheinkestel C, Su S. Intensity of renal replacement therapy in critically ill patients. N Engl J Med. 2009;361:1627–1638. doi: 10.1056/NEJMoa0902413.
    1. Vinsonneau C, Camus C, Combes A, Costa de Beauregard MA, Klouche K, Boulain T, Pallot JL, Chiche JD, Taupin P, Landais P, Dhainaut JF. Hemodiafe Study Group. Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial. Lancet. 2006;368:379–385. doi: 10.1016/S0140-6736(06)69111-3.
    1. VA/NIH Acute Renal Failure Trial Network. Palevsky PM, Zhang JH, O'Connor TZ, Chertow GM, Crowley ST, Choudhury D, Finkel K, Kellum JA, Paganini E, Schein RM, Smith MW, Swanson KM, Thompson BT, Vijayan A, Watnick S, Star RA, Peduzzi P. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359:7–20. doi: 10.1056/NEJMoa0802639.
    1. Gibney RTN, Bagshaw SM, Kutsogiannis DJ, Johnston C. When should renal replacement therapy for acute kidney injury be initiated and discontinued. Blood Purif. 2008;26:473–484. doi: 10.1159/000157325.
    1. Seabra VF, Balk EM, Liangos O, Sosa MA, Cendoroglo M, Jaber BL. Timing of renal replacement initiation in acute renal failure: a meta-analysis. Am J Kidney Dis. 2008;52:272–284. doi: 10.1053/j.ajkd.2008.02.371.

Source: PubMed

3
Sottoscrivi