The effectiveness of continuous renal replacement therapy for patients with multiple organ dysfunction syndrome and different severity of acute kidney injury

Objective To investigate the prognosis of patients with multiple organ dysfunction syn- drome (MODS) using continuous renal replacement therapy for the treatment of their acute kidney injury (AKI) in different severity. Methods We retrospective studied 240 patients with MODS treated with continu- ous veno-venous hemofiltration (CVVH) in the period of Jan. 2004 to Dec. 2006. The severity of AKI in these patients was classified as AKI of phase I, II and III according to the RIFLE criteria. The mortality rate in hospital and the number of failed organs were compared among patients with different severity of AKI. Their APACHE II score, sequential organ failure assessment (SOFA) score, mean arterial pressure, oxygenate index, blood urea nitrogen and serum creatinine were also compared before and after CVVH for 24 hours. Results ① The overall mortality rate in hospital was 38.75%. The rate was higher in patients with AKI of phase III than those with phase I and II (P 0.05). ② The number of failed organs was higher in patients with severe AKI. Patients with more failed organs had significantly higher mortality rate in hospital. Patients presenting ≥ 4 failed organs had higher mortality rate in hospital than those showing ≤ 3 failed organs (75.5% vs 13.4%, P 0.05). ③ After CVVH for 24 hours, mean arterial pressure, oxygenate index, blood urea nitrogen and serum creatinine improved significantly in all patients. APACHE II score and SOFA score decreased significantly in patients with AKI of phase I and II, but insignificantly in those with AKI of phase III. Conclusions CVVH is an effective measure for MODS patients complicated with severe acute renal failure. RIFLE criteria is useful for the early diagnosis and prognosis prediction of AKI. CVVH remarkably improves the prognosis of MODS with AKI of phase I or II.