Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/11470
Title: A risk, injury, failure, loss, and end-stage renal failure score-based trigger for renal replacement therapy and survival after cardiac surgery.
Authors: Schneider, Antoine G;Eastwood, Glenn M;Seevanayagam, Siven;Matalanis, Georges;Bellomo, Rinaldo
Affiliation: Intensive Care Unit, Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia.
Issue Date: 3-Apr-2012
Citation: Journal of Critical Care 2012; 27(5): 488-95
Abstract: It is controversial whether all critically ill patients with risk, injury, failure, loss, and end-stage renal failure (RIFLE) F class acute kidney injury (AKI) should receive renal replacement therapy (RRT). We reviewed the outcome of open heart surgery patients with severe RIFLE-F AKI who did not receive RRT.We identified all patients with AKI after cardiac surgery over 4 years and obtained baseline characteristics, intraoperative details, and in-hospital outcomes. We analyzed physiologic and biochemical features at RRT initiation or at peak creatinine if no RRT was provided.We reviewed 1504 patients. Of these, 137 (9.1%) developed postoperative AKI with 71 meeting RIFLE-F criteria and 23 (32.4% of RIFLE-F cases) not receiving RRT. Compared with RRT-treated RIFLE-F patients, "no-RRT" patients had lower Acute Physiology and Chronic Health Evaluation III scores, less intra-aortic balloon pump requirements, shorter intensive care stay, and a trend toward lower mortality. At peak RIFLE score, their urinary output, arterial pH, and Pao(2)/fraction of inspired oxygen ratio were all significantly higher. Their serum creatinine was also higher (304 vs 262 μmol/L; P = .02). Only 3 RIFLE-F no-RRT patients died in-hospital. Detailed review of cause and mode of death was consistent with non-RRT-preventable deaths. In contrast, 27 patients with RIFLE-R or RIFLE-I class received RRT. Compared with RRT-treated RIFLE-F patients, such RIFLE-R or RIFLE-I treated patients had a more severe presentation and higher mortality (51.8% vs 29.2%; P = .02).After cardiac surgery, RRT was typically applied to patients with the most severe clinical presentation irrespective of creatinine levels. A RIFLE score-based trigger for RRT is unlikely to improve patient survival.
Internal ID Number: 22480577
URI: http://ahro.austin.org.au/austinjspui/handle/1/11470
DOI: 10.1016/j.jcrc.2012.02.008
URL: http://www.ncbi.nlm.nih.gov/pubmed/22480577
Type: Journal Article
Subjects: Acute Kidney Injury.diagnosis.mortality.therapy
Aged
Aged, 80 and over
Blood Chemical Analysis
Cardiac Surgical Procedures
Creatinine.blood
Critical Illness
End Stage Liver Disease.diagnosis.mortality.therapy
Female
Humans
Male
Middle Aged
Patient Acuity
Renal Replacement Therapy.methods
Appears in Collections:Journal articles

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