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Timing the initiation of renal replacement therapy for acute kidney injury in Canadian intensive care units: a multicentre observational study |
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| Authors: | Edward Clark MD Ron Wald MD Adeera Levin MD Josée Bouchard MD Neill K. J. Adhikari MD Michelle Hladunewich MD Robert M. A. Richardson MD Matthew T. James MD Michael W. Walsh MD Andrew A. House MD Louise Moist MD Daniel E. Stollery MD Karen E. A. Burns MD Jan O. Friedrich MD James Barton MD Jean-Philippe Lafrance MD Neesh Pannu MD Sean M. Bagshaw MD |
| Affiliation: | 1. Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada 2. University of Toronto and the Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael??s Hospital, Toronto, ON, Canada 3. St. Paul??s Hospital, Vancouver, BC, Canada 4. H?pital du Sacr??-Coeur, Universit?? de Montr??al, Montreal, QC, Canada 5. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada 6. Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada 7. Toronto General Hospital, University of Toronto, Toronto, ON, Canada 8. Foothills Medical Centre/Peter Lougheed Centre, Calgary, AB, Canada 9. McMaster University, Hamilton, ON, Canada 10. University Hospital/Victoria Hospital, London Health Sciences Centre, London, ON, Canada 11. Division of Critical Care Medicine, Grey Nuns Community Hospital, Edmonton, AB, Canada 12. St. Paul??s Hospital, Saskatoon, SK, Canada 13. H?pital Maisonneauve-Rosemont, Universit?? de Montr??al, Montreal, QC, Canada 14. Division of Nephrology, University of Alberta, Edmonton, AB, Canada 15. Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 3C1.16 Walter C. Mackenzie Centre, 8440-122 Street, Edmonton, AB, T6G 2B7, Canada |
| Abstract: | PurposeThe optimal timing for starting renal replacement therapy (RRT) in patients with acute kidney injury (AKI) is unknown. Defining current practice is necessary to design interventional trials. We describe the current Canadian practice regarding the timing of RRT initiation for AKI.MethodsAn observational study of patients undergoing RRT for AKI was undertaken at 11 intensive care units (ICUs) across Canada. Data were captured on demographics, clinical and laboratory findings, indications for RRT, and timing of RRT initiation.ResultsAmong 119 consecutive patients, the most common ICU admission diagnosis was sepsis/septic shock, occurring in 54%. At the time of RRT initiation, the median and interquartile range (IQR) serum creatinine level was 322 (221-432) ??mol·L?1. The mean (SD) values for other parameters were as follows: Sequential Organ Failure Assessment (SOFA) score 13.4 (4.1), pH 7.25 (0.15), potassium 4.6 (1.0) mmol·L?1. Also, 64% fulfilled the serum creatinine-based criterion for Acute Kidney Injury Network (AKIN) stage 3. Severity of illness, measured using Acute Physiology and Chronic Health Evaluation (APACHE II) and SOFA scores, did not correlate with AKI severity as defined by the serum creatinine-based AKIN criteria. Median (IQR) time from hospital and ICU admission to the start of RRT was 2.0 (1.0-7.0) days and 1.0 (0-2.0) day, respectively.ConclusionPatients admitted to an ICU who were started on RRT generally had advanced AKI, high-grade illness severity, and multiorgan dysfunction. Also, they were started on RRT shortly after hospital presentation. We describe the current state of practice in Canada regarding the initiation of RRT for AKI in critically ill patients, which can inform the designs of future interventional trials. |
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