Late initiation of renal replacement therapy is associated with worse outcomes in acute kidney injury after major abdominal surgery

Shiao, Chih-Chung; Wu, Vin-Cent; Li, Wen-Yi; Lin, Yu-Feng; Hu, Fu-Chang; Young, Guang-Huar; Kuo, Chin-Chi; Kao, Tze-Wah; Huang, Down-Ming; Chen, Yung-Ming; Tsai, Pi-Ru; Lin, Shuei-Liong; Chou, Nai-Kuan; Lin, Tzu-Hsin; Yeh, Yu-Chang; Wang, Chih-Hsien; Chou, Anne; Ko, Wen-Je; Wu, Kwan-Dun

doi:10.1186/cc8147

Critical Care

Table 2 Comparisons of demographic data and clinical parameters between early and late dialysis groups (n = 98)

From: Late initiation of renal replacement therapy is associated with worse outcomes in acute kidney injury after major abdominal surgery

	Early dialysis (n = 51)	Late dialysis (n = 47)	P value
Demographic data
Female	19 (37.3)	22(46.8)	0.414
Diabetes	14 (27.5)	17 (36.2)	0.391
Hypertension	22 (43.1)	20 (42.6)	1.000
Cardiac failure	6 (11.8)	4 (8.5)	0.743
Chronic kidney disease	28 (54.9)	13 (27.7)	0.008
Sepsis before RRT	14 (27.5)	17 (36.2)	0.391
Emergency surgery	23 (45.1)	19 (40.4)	0.686
CVVH	26 (51.0)	31 (66.0)	0.155
Mechanical ventilation	39 (76.5)	40 (85.1)	0.316
Age (years)	65.0 ± 14.8	68.0 ± 13.0	0.284
Old age (> 65 years)	27 (52.9)	30 (63.8)	0.310
Hospital stay (days)	53.7 ± 39.2	54.2 ± 33.6	0.944
Hospital admission to ICU (days)	10.3 ± 15.5	12.6 ± 13.0	0.423
Hospital admission to RRT (days)	17.5 ± 20.3	21.0 ± 19.0	0.388
ICU to RRT (days)	7.3 ± 13.2	8.4 ± 13.6	0.679
RRT to death/discharge (days)	35.5 ± 29.0	33.1 ± 26.2	0.671
Baseline creatinine (mg/dl)	2.1 ± 1.7	1.3 ± 0.6	0.003
Baseline GFR (ml/min/1.73 m²)	47.7 ± 27.2	60.6 ± 28.5	0.024
Operation sites ^a			0.592
Hepatobiliary system	13 (25.5)	13 (27.7)
Upper GI	13 (25.5)	15 (31.9)
Lower GI	15 (29.4)	14 (29.8)
Urologic system	7 (13.7)	2 (4.3)
Other sites	3 (5.9)	3 (6.4)
Data at ICU admission
Diuretics	43 (84.3)	35 (74.5)	0.316
Vasopressors	27 (52.9)	25 (53.2)	1.000
Inotropic equivalent	7.80 ± 12.63	5.96 ± 9.87	0.426
Hematocrit (%)	29.3 ± 7.3	31.5 ± 5.5	0.105
BUN (mg/dl)	50.9 ± 33.0	41.9 ± 27.0	0.143
Creatinine (mg/dl)	2.9 ± 1.9	2.3 ± 1.4	0.137
GFR (ml/min/1.73 m²)	39.5 ± 50.0	38.6 ± 26.7	0.917
Albumin (g/dl)	2.8 ± 0.6	2.6 ± 0.7	0.231
Potassium (mEq/l)	4.2 ± 0.7	4.1 ± 0.7	0.552
PaO₂/FiO₂	281.1 ± 112.1	273.0 ± 1 20.9	0.732
GCS scores	13.4 ± 3.3	12.6 ± 3.8	0.304
APACHE II scores	18.2 ± 5.4	18.8 ± 6.3	0.620
SOFA scores	8.3 ± 2.7	8.5 ± 3.7	0.767
Pre-RRT data
Hematocrit (%)	28.5 ± 4.8	29.4 ± 5.0	0.374
BUN (mg/dl)	68.8 ± 39.4	81.9 ± 39.3	0.104
Creatinine (mg/dl)	3.3 ± 1.8	3.8 ± 1.3	0.188
GFR (ml/min/1.73 m²)	32.8 ± 50.3	17.5 ± 7.8	0.036
Albumin (g/dl)	2.8 ± 0.6	2.8 ± 0.7	0.722
Potassium (mEq/l)	4.2 ± 0.8	4.3 ± 0.7	0.740
PaO2/FiO2	300.3 ± 112.1	280.2 ± 119.5	0.395
GCS scores	12.5 ± 3.9	11.3 ± 4.5	0.160
APACHE II scores	18.2 ± 6.1	20.5 ± 5.8	0.061
SOFA scores	9.4 ± 3.1	10.5 ± 3.8	0.114
Indications for RRT
Azotemia with uremic symptoms^b	19 (37.3)	23 (48.9)	0.308
Oliguria or anuria^c	23 (45.1)	17 (36.2)	0.415
Fluid overload or pulmonary edema^d	4 (7.8)	6 (12.8)	0.513
Hyperkalemia or acidosis^e	8 (15.7)	6 (12.8)	0.717
Hospital mortality	22 (43.1)	35 (74.5)	0.002
RRT wean-off	21 (41.2)	10 (21.3)	0.050

Early dialysis group, RIFLE-0 (n = 22) and --R (n = 29); Late dialysis group, RIFLE-I (n = 27) and --F (n = 20).
Values are presented as mean ± standard deviation or number (percentage) unless otherwise stated. ^aupper GI denotes duodenum and above, lower GI means jejunum and below, other sites denote surgery site besides previous four; ^b azotemia was defined as BUN > 80 mg/dL and creatinine > 2 mg/dL; ^coliguria was defined as urine output < 200 ml/8 hours refractory to diuretics; ^dfluid overload means CVP > 12 mmHg, while pulmonary edema denotes PaO₂/FiO₂ < 300 mmHg; ^e hyperkalemia denotes serum potassium > 5.5 mmol/L, acidosis denotes pH < 7.2 in arterial blood.
APACHE II = Acute Physiology and Chronic Health Evaluation II; BMI = body mass index; BUN = blood urea nitrogen; CVP = central venous pressure; CVVH = continuous venovenous hemofiltration; FiO2 = fraction of inspired oxygen; GCS = Glascow Coma Scale; GFR = glomerular filtration rate; GI = gastrointestinal; ICU = intensive care unit; MAP = mean arterial pressure; PaO2 = partial pressure of arterial oxygen; RRT = renal replacement therapy; SOFA = Sequential Organ Failure Assessment; WBC = white blood cell.

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