Optimal time of continuous renal replacement therapy for treatment of sepsis-induced patients with acute kidney injury

OBJECTIVE To evaluate the relationship between the classification for acute kidney injury(AKI) in RIFLE criteria and the prognosis of sepsis-induced patients with multiple organ dysfunction syndrome(MODS) due to continuous renal replacement therapy(CRRT) so as to find the optimal time to start the CRRT for AKI patients.METHODS We prospectively studied 121 sepsis-induced patients with AKI from Jan 2008 to Jan 2011 by using random and case-control survey.These patients,according to the RIFLE criteria,were divided into three groups:AKI of phase I,Ⅱ and Ⅲ;we compared the mortality rate in hospital and the recovery rate of renal function among the three groups;at the same time,their sequential organ failure assessment(SOFA) score,APACHE Ⅱ score,the patients needing vasoactive agent,procalcitonin(PCT),mean arterial pressure,oxygenate index were also compared 48 hours before and after CVVH.RESULTS The mortality rates in hospital among AKI of phase I,Ⅱ and Ⅲ were 21.4%,25.6% and 47.5%;the mortality rate was significantly higher in patients with AKI of phase Ⅲ than in those with phase I and Ⅱ;the recovery rates of renal function among AKI of phase I,Ⅱ and Ⅲ were 76.2%,53.8% and 22.5%,the recovery rate of renal function was significantly higher in patients with AKI of phase I and Ⅱ than in those with phase Ⅲ;APACHE Ⅱ score,SOFA score and PCT decreased significantly in patients with AKI of phase I and Ⅱ 48 hours after CVVH,the differences were statistically significant(P0.05);there was no significant change in those with AKI of phase Ⅲ(P0.05).CONCLUSION CRRT is effective in the treatment of sepsis-induced MODS.Using CRRT during AKI of phase I,Ⅱ can significantly improve the prognosis of sepsis-induced patients with MODS,on the contrary,the prognosis of sepsis-induced patients with MODS can not be improved during the AKI of phase Ⅲ.The optimal timing of CRRT is very important during the clinical practice.