Prognostic factors in Acute Kidney Injury Patients on the Stage 3 of AKI-KDIGO Classification who were managed with CRRT in ICU

초록

Background: Continuous renal replacement therapy (CRRT) has been widely used for treating critically ill patients with severe acute kidney injury(AKI). Prognosis of AKI patients is different according to the combined underlying condition. Those factors in the AKI patients on the stage 3 of new 2012 clinical practice guideline of AKI in the Kidney Disease: Improving Global Outcomes (AKI-KDIGO) are need to be assessed for realistic outcomes with CRRT. Methods: We investigated the prognostic factors of AKI patients who were managed with CRRT in intensive care unit (ICU). We reviewed 128 patients with AKI who were admitted to ICU from June, 2013 to June, 2014. They had meted all the new criteria of stage 3 of AKI-KDIGO guidelines. Forteen factors were analyzed to find risk factors influencing mortality. There were excluded patients who had stopped CRRT within 48 hours. Results: The mean age was 57.3±16.2 years old. The cause of AKI were sepsis(55 cases, 44%), dehydration(32 cases, 25%), rhabdomyolysis(12 cases, 9%), drugs intoxication(8 cases, 6%), urinary tract obstruction(7 cases, 5%), hepatorenal syndrome(4 cases, 3%), other medical diseases(4 cases, 3%). The cause of death were septic shock(10 cases, 27%), cardiac failure(8cases, 22%), respiratory failure(7cases, 19%), disseminated intravascular coagulation(DIC) (3 cases, 8%). The average of initial APACHE II score were 21.9 ±6.5 and 26.5±5.4 in survivors and non-survivors, respectively. Univariate analyses showed that higher APACHE II score, and serum bicarbonate level 48 hours after CRRT was more higher in survivors than non-survivors. Multivariate analyses revealed that APACHE II score (OR: 1.16; 95% Cl 1.04-1.36; p=0.04), pre-CRRT oliguria (OR: 12.31; 95% Cl 1.19-125.46; p<0.0013) were independent predictors for the prediction of mortality.