J Korean Med Sci.  2024 Nov;39(43):e276. 10.3346/jkms.2024.39.e276.

Impact of Early Continuous Kidney Replacement Therapy in Patients With Sepsis-Associated Acute Kidney Injury: An Analysis of the MIMIC-IV Database

• Lee Y
• Seo JH
• Seong J
• Ahn SM
• Han M
• Lee JA
• Kim JH
• Ahn JY
• Jeong SJ
• Choi JY
• Yeom JS
• Oh HJ
• Ku NS

• KMID: 2561427
• DOI: http://doi.org/10.3346/jkms.2024.39.e276

Abstract

Background
Renal replacement therapy (RRT) is an important treatment option for sepsisassociated acute kidney injury (AKI); however, the optimal timing for its initiation remains controversial. Herein, we investigated the clinical outcomes of early continuous kidney replacement therapy (CKRT), defined as CKRT initiation within 6 hours of sepsis-associated AKI onset, which was earlier than the initiation time defined in previous studies.
Methods
We used clinical data sourced from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. This study included patients aged ≥ 18 years who met the sepsis diagnostic criteria and received CKRT because of stage 2 or 3 AKI. Early and late CKRTs were defined as CKRT initiation within 6 hours and after 6 hours of the development of sepsisassociated AKI, respectively.
Results
Of the 33,236 patients diagnosed with sepsis, 553 underwent CKRT for sepsisassociated AKI. After excluding cases of early mortality and patients with a dialysis history, 45 and 334 patients were included in the early and late CKRT groups, respectively. After propensity score matching, the 28-day mortality rate was significantly lower in the early CKRT group than in the late CKRT group (26.7% vs. 43.9%, P = 0.035). The early CKRT group also had a significantly greater number of days free of mechanical ventilation (median, 19; interquartile range [IQR], 3–25) and vasopressor administration (median, 21; IQR, 5–26) than the late CKRT group did (median, 10.5; IQR, 0–23; P = 0.037 and median, 13.5; IQR, 0–25; P = 0.028, respectively). The Kaplan–Meier curve also showed that early CKRT initiation was associated with an improved 28-day mortality rate (log-rank test, P = 0.040). In contrast, there was no significant difference in the 28-day mortality between patients who started CKRT within 12 hours and those who did not (log-rank test, P = 0.237).
Conclusion
Early CKRT initiation improved the survival of patients with sepsis-associated AKI. Initiation of CKRT should be considered as early as possible after sepsis-associated AKI onset, preferably within 6 hours.

Keyword

Renal Replacement Therapy; Acute Kidney Injury; Sepsis; Mortality

Figure

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  Fig. 1 Study flowchart.AKI = acute kidney injury, CKRT = continuous kidney replacement therapy.

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  Fig. 2 Kaplan–Meier survival curves of patients with sepsis-associated acute kidney injury after propensity score matching. (A) Comparison of 28-day survival with CKRT initiated within 6 hours and after 6 hours and (B) within 12 hours and after 12 hours. (C) Ninety-day mortality among patients with sepsis and those with CKRT initiated within 6 hours and after 6 hours and (D) within 12 hours and after 12 hours.CKRT = continuous kidney replacement therapy.

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