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dc.contributor.authorSchneider, Antoine Gen
dc.contributor.authorEastwood, Glenn Men
dc.contributor.authorSeevanayagam, Sivenen
dc.contributor.authorMatalanis, Georgesen
dc.contributor.authorBellomo, Rinaldoen
dc.identifier.citationJournal of Critical Care 2012; 27(5): 488-95en
dc.description.abstractIt 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.en
dc.subject.otherAcute Kidney Injury.diagnosis.mortality.therapyen
dc.subject.otherAged, 80 and overen
dc.subject.otherBlood Chemical Analysisen
dc.subject.otherCardiac Surgical Proceduresen
dc.subject.otherCritical Illnessen
dc.subject.otherEnd Stage Liver Disease.diagnosis.mortality.therapyen
dc.subject.otherMiddle Ageden
dc.subject.otherPatient Acuityen
dc.subject.otherRenal Replacement Therapy.methodsen
dc.titleA risk, injury, failure, loss, and end-stage renal failure score-based trigger for renal replacement therapy and survival after cardiac surgery.en
dc.typeJournal Articleen
dc.identifier.journaltitleJournal of Critical Careen
dc.identifier.affiliationIntensive Care Unit, Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australiaen
dc.type.austinJournal Articleen
item.openairetypeJournal Article-
item.fulltextNo Fulltext- Care- Care- Analytics Research and Evaluation (DARE) Centre-
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