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Báo cáo y học: "Initiation of renal replacement therapy: is timing everything"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Initiation of renal replacement therapy: is timing everything? | Bouman and Forni Critical Care 2010 14 107 http ccforum.eom content 14 1 107 CRITICAL CARE COMMENTARY L__ Initiation of renal replacement therapy is timing everything Catherine SC Bouman 1 and Lui G Forni2 See related research by Ostermann and Chang http ccforum.eom content 13 6 R175 Abstract Acute kidney injury is commonly encountered and in the critically ill treatment is principally supportive. A recent large multicentre study has used retrospective analysis to try and identify patient outcomes when commencing renal replacement therapy using conventional biochemical and physiological markers. The authors have also made an attempt to decipher when to commence renal replacement therapy. Acute kidney injury AKI remains a commonly encountered medical problem often finding its way to the intensive care unit ICU . Treatment involves normalisation of the circulation and failing that renal replacement therapy RRT of whatever type. The interesting paper by Ostermann and Chang describes the correlation between parameters at initiation of RRT and outcome in critically ill patients who underwent RRT 1 . Although the study is retrospective it is however multicentred and includes a large number of patients. ICU survivors 55.9 were significantly younger and less sick with less pre-existing chronic illnesses. In a multivariate analysis mechanical ventilation and associated neurological failure on the day of RRT were the strongest independent risk factors for mortality followed by hepatic gastrointestinal and haematological failure and pre-existing health problems. A higher serum pH was independently associated with a better outcome. A raised urea and a low creatinine concentration at initiation of RRT were independent risk factors for dying. Similar risk factors for death from AKI have been identified in the past albeit at a single centre and Correspondence c.s.bouman@amc.uva.nl department of Intensive Care Academic Medical Center University of Amsterdam PO Box 22660 .