RESUMO

Acute kidney injury (AKI) is a common complication among critical illnesses. In severe cases, renal replacement therapy (RRT) is required. It has been reported that hospital mortality of the patients who require RRT is more than 60%. Because of the high mortality, it is quite important to conduct RRT appropriately to improve outcome of patients with severe AKI. However, RRT is not a single homogeneous therapy but rather there are diverse modes of therapy and various ways of providing RRT that might affect its efficacy and safety. The Acute Dialysis Quality Initiative (ADQI) reviewed the available evidence and recommended that more research should be conducted on such technical aspects of RRT in order to determine if certain techniques are preferred for certain indications. As a response to the recommendation by ADQI, the BEST Kidney (Beginning and Ending Supportive Therapy for the Kidney) study was conducted. This study is a multicenter, multinational, prospective, epidemiological study with the aim of understanding multiple aspects of AKI at an international level. This study was conducted at 54 centers in 23 countries from September 2000 to December 2001. The study included more than 1,700 patients including 1,260 who were treated with RRT. Using the large database, several aspects related to RRT have been analyzed, including comparison of IRRT and continuous RRT (CRRT), timing of RRT initiation and discontinuation, and practice variations for CRRT around the world. This study found that RRT practice was quite varied around the world. RRT practice is not aligned with the best evidence and variations in practice may be responsible for significant morbidity. The BEST Kidney Study has generated several hypotheses related to RRT practice in the intensive care unit. Such hypotheses will need to be tested in future clinical trials and hopefully help reduce practice variations for patients with AKI requiring RRT.

Assuntos

Injúria Renal Aguda/terapia , Unidades de Terapia Intensiva , Terapia de Substituição Renal/normas , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/mortalidade , Anticoagulantes/uso terapêutico , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/mortalidade , Ásia , Austrália , Estado Terminal , Europa (Continente) , Saúde Global , Humanos , Hipotensão/epidemiologia , América do Norte , Diálise Peritoneal , Terapia de Substituição Renal/efeitos adversos , Terapia de Substituição Renal/métodos , Terapia de Substituição Renal/estatística & dados numéricos , América do Sul , Taxa de Sobrevida , Resultado do Tratamento

RESUMO

PURPOSE: The aim of this study is to evaluate the relationship between timing of renal replacement therapy (RRT) in severe acute kidney injury and clinical outcomes. METHODS: This was a prospective multicenter observational study conducted at 54 intensive care units (ICUs) in 23 countries enrolling 1238 patients. RESULTS: Timing of RRT was stratified into "early" and "late" by median urea and creatinine at the time RRT was started. Timing was also categorized temporally from ICU admission into early (<2 days), delayed (2-5 days), and late (>5 days). Renal replacement therapy timing by serum urea showed no significant difference in crude (63.4% for urea 24.2 mmol/L; odds ratio [OR], 0.92; 95% confidence interval [CI], 0.73-1.15; P = .48) or covariate-adjusted mortality (OR, 1.25; 95% CI, 0.91-1.70; P = .16). When stratified by creatinine, late RRT was associated with lower crude (53.4% for creatinine >309 micromol/L vs 71.4% for creatinine

Assuntos

Injúria Renal Aguda/terapia , Cuidados Críticos/métodos , Estado Terminal/terapia , Seleção de Pacientes , Terapia de Substituição Renal/métodos , Injúria Renal Aguda/sangue , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/mortalidade , Austrália/epidemiologia , Nitrogênio da Ureia Sanguínea , Brasil/epidemiologia , Causalidade , China/epidemiologia , Creatinina/sangue , Estado Terminal/mortalidade , Europa (Continente) , Feminino , Mortalidade Hospitalar , Humanos , Japão/epidemiologia , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , América do Norte/epidemiologia , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento