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235 STARTING EARLY ON CONTINUOUS RENAL REPLACEMENT THERAPY IMPROVES SURVIVAL IN PATIENTS WITH PREEXISTING RENAL DISEASE.
  1. H. S. Brar,
  2. C. J. LeBrun,
  3. W. Gabbard
  1. University of Missisippi Medical Center, Jackson, MS

Abstract

Background Mortality rates with continuous renal replacement therapy (CRRT) remain high. Issues that remain unanswered include the timing of initiation, the dose of CRRT, and patient characteristics that predict mortality.

Objective To compare survival of patients with acute renal failure (ARF) with or without preexisting renal dysfunction on admission at 24 hrs, 48 hrs, and more than 48 hrs of waiting period before the initiation of CRRT.

Design We carried out an observational study of 96 consecutive CRRT patients at our institution from Jan 2003 to June 2004. There were 2 arms of the study: those without preexisting renal disease who developed acute renal failure after admission (Inpt-ARF; defined as a serum creatnine [Scr] of less than 1.3 mg/dL prior to ARF and CRRT) (n = 56) and those with renal dysfunction on admission (CKD-ARF; Scr of greater than or equal to 1.3 mg/dL prior to ARF and CRRT) (n = 40). We compared the survival of the two groups (Inpt-ARF versus CKD-ARF - time waited for the initiation of CRRT; age; Apache II score; acidosis; BUN and Scr change; dose of dialysis in each group; URR; UF; urea clearance; time on CRRT). We split our database into 3 groups depending on time of initiation and compared survival using Kaplan-Meier survival analysis. Group 1 consisted of patients in which CRRT was started within 24 hrs, Group 2 within 48 hrs but not in first 24 hrs, and Group 3 more than 48 hrs. Data were analyzed using SPSS-13 for hazard function, Kaplan-Meier survival analysis, ANOVA, and descriptive statistics.

Results Overall survival at 30 days post-initiation of CRRT was approximately 48%. Survival in CKD-ARF group 1, 78%; group 2, 57%; and group 3, 35% (p value .039). Kaplan-Meier survival analysis and hazard function showed a better survival in early initiation on CRRT. Survival in ARF group was Group 1, 44%; group 2, 33%; and group 3, 40%. However, it did not reach statistical significance (p value .84). There was no statistically significant difference in age; Apache II score; acidosis; BUN and Scr change; dose of dialysis in each group; URR; UF; urea clearance; time on CRRT. Overall survival in Inpt-ARF group was 37% while the CKD-ARF group had 57% survival. The percentage of survivors needing dialysis support at 30 days post initiation of CRRT was lower in the CKD-ARF group than in the Inpt-ARF group.

Conclusion Timing from renal insult to initiation of CRRT plays a role in predicting survival of patients in our CRRT database. Patients on CRRT with preexisting renal disease who were started early had better survival; however, the same cannot be said about the ARF group as it did not reach statistical significance.

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