Renal Recovery from Severe Acute Kidney Injury Requiring Renal Replacement Therapy.
- Author:
Kyung A CHOI
1
;
Jeong Ah KWON
;
Young Hoon KIM
;
Yu Ji LEE
;
Ha Young OH
;
Dae Joong KIM
;
Yoon Goo KIM
;
Wooseong HUH
;
Jung Eun LEE
Author Information
1. Department of Medicine, Sungkyunkwan University School of Medicine Samsung Medical Center, Seoul, Korea. jungeun34.lee@samsung.com
- Publication Type:Original Article
- Keywords:
Acute renal failure (ARF);
Renal tubule necrosis;
Renal replacement therapy;
Prognostic
- MeSH:
Acute Kidney Injury;
Creatinine;
Critical Illness;
Dialysis;
Humans;
Kidney Cortex Necrosis;
Male;
Multivariate Analysis;
Necrosis;
Oliguria;
Renal Insufficiency, Chronic;
Renal Replacement Therapy;
Retrospective Studies
- From:Korean Journal of Nephrology
2009;28(4):295-301
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Acute tubular necrosis (ATN) is a serious complication in critically ill patients. This study investigated the renal outcome of severe ATN requiring RRT and prognostic factors for renal recovery. METHODS: Between January 2000 and May 2008, surviving patients with presumed ATN requiring dialysis were analyzed retrospectively. Patients with pre-existing chronic kidney disease and other causes of ARF rather than ATN were excluded. Primary outcomes were complete renal recovery (CR) and dialysis withdrawal. CR was defined as a return to basal serum creatinine level or creatinine <1.5 mg/dL (male) or <1.3 mg/dL (female) without dialysis. RESULTS: Of one hundred twenty two patients, 79 (65%) patients were male. The mean age was 54+/-16 years and 87 patients (71%) received continuous renal replacement therapy. 55% had ischemic ATN, 29% had septic ATN, and 16% had nephrotoxic ATN. Mean duration of dialysis was 12 (6-29) days. Dialysis withdrawal rate at 30 days and at 60 days after initiation of dialysis were 51% and 77 %, respectively. CR at 60 days after initiation was 50%. Multivariate analysis revealed that older age (per year, Hazard ratio (HR)=0.981, 95% Confidence interval (CI) 0.963 to 0.999), ischemic ATN (vs. toxic ATN, HR=0.481, 95% CI 0.238 to 0.974),and longer duration of oliguria (per day, HR=0.979, 95 % CI 0.962 to 0.996) were independent prognostic factors of renal recovery. CONCLUSION: Young age and short duration of oliguria were favorable factors for renal recovery from ATN requiring dialysis. The cause of ATN might be also an independent prognostic factor.
