Introduction: One of the top research priorities in acute kidney injury is related to the timing of renal replacement therapy (RRT) initiation. The purpose was to develop an index that might serve as a standardized concept of timing of initiation of RRT. Methods: A previously described database was used. We applied a multivariable Cox regression model with backward selection to characterize parameters present in those patients who received RRT compared with those who did not receive RRT. Results: We studied 590 patients. We identified independent risk factors for RRT and a risk score was devised. The Area Under the Curve of the receiver operating characteristic curve was 0.81 (95% CI 0.74-0.86) for predicting the need for RRT. Conclusions: We have developed a simple Score (IRRIV Score) to identify patients at high risk of requiring RRT. This score may serve as a standardized definition of the timing of initiation of RRT.

Keywords:
Renal replacement therapy, Intensive care, Acute kidney injury, Fluid overload
1.
Bagshaw SM, George C, Bellomo R: Early acute kidney injury and sepsis: a multicentre evaluation. Crit Care 2008;12:R47.
2.
Bagshaw SM, George C, Bellomo R: A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant 2008;23:1569-1574.
3.
Lopes JA, Fernandes P, Jorge S, Gonçalves S, Alvarez A, Costa e Silva Z, et al: Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the acute kidney injury network classifications. Crit Care 2008;12:R110.
4.
Thakar CV, Christianson A, Freyberg R, Almenoff P, Render ML: Incidence and outcomes of acute kidney injury in intensive care units: a Veterans administration study. Crit Care Med 2009;37:2552-2558.
5.
Bagshaw SM, Laupland KB, Doig CJ, Mortis G, Fick GH, Mucenski M, et al: Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study. Crit Care 2005;9:R700-R709.
6.
Ostermann M, Chang RW: Correlation between parameters at initiation of renal replacement therapy and outcome in patients with acute kidney injury. Crit Care 2009;13:R175.
7.
Srisawat N, Lawsin L, Uchino S, Bellomo R, Kellum JA: Cost of acute renal replacement therapy in the intensive care unit: results from the beginning and ending supportive therapy for the kidney (BEST kidney) study. Crit Care 2010;14:R46.
8.
Manns B, Doig CJ, Lee H, Dean S, Tonelli M, Johnson D, et al: Cost of acute renal failure requiring dialysis in the intensive care unit: clinical and resource implications of renal recovery. Crit Care Med 2003;31:449-455.
9.
Kellum JA, Mehta RL, Levin A, Molitoris BA, Warnock DG, Shah SV, et al: Development of a clinical research agenda for acute kidney injury using an international, interdisciplinary, three-step modified Delphi process. Clin J Am Soc Nephrol 2008;3:887-894.
10.
Basu RK: Adding more fuel to the acute kidney injury fire: delay in initiation of continuous renal replacement therapy is associated with poor outcome. Crit Care Med 2014;42:1004-1005.
11.
Clark E, Wald R, Walsh M, Bagshaw SM: Timing of initiation of renal replacement therapy for acute kidney injury: a survey of nephrologists and intensivists in Canada. Nephrol Dial Transplant 2012;27:2761-2767.
12.
Karvellas CJ, Farhat MR, Sajjad I, Mogensen SS, Leung AA, Wald R, et al: A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis. Crit Care 2011;15:R72.
13.
Elahi M, Asopa S, Pflueger A, Hakim N, Matata B: Acute kidney injury following cardiac surgery: impact of early versus late haemofiltration on morbidity and mortality. Eur J Cardiothorac Surg 2009;35:854-863.
14.
Joannidis M, Forni LG: Clinical review: timing of renal replacement therapy. Crit Care 2011;15:223.
15.
Wu VC, Ko WJ, Chang HW, Chen YS, Chen YW, Chen YM, et al: Early renal replacement therapy in patients with postoperative acute liver failure associated with acute renal failure: effect on postoperative outcomes. J Am Coll Surg 2007;205:266-276.
16.
Shiao CC, Wu VC, Li WY, Lin YF, Hu FC, Young GH, et al: Late initiation of renal replacement therapy is associated with worse outcomes in acute kidney injury after major abdominal surgery. Crit Care 2009;13:R171.
17.
Liu KD, Himmelfarb J, Paganini E, Ikizler TA, Soroko SH, Mehta RL, et al: Timing of initiation of dialysis in critically ill patients with acute kidney injury. Clin J Am Soc Nephrol 2006;1:915-919.
18.
Schneider AG, Eastwood GM, Seevanayagam S, Matalanis G, Bellomo R: A risk, injury, failure, loss, and end-stage renal failure score-based trigger for renal replacement therapy and survival after cardiac surgery. J Crit Care 2012;27:488-495.
19.
Jun M, Bellomo R, Cass A, Gallagher M, Lo S, Lee J: Timing of renal replacement therapy and patient outcomes in the randomized evaluation of normal versus augmented level of replacement therapy study. Crit Care Med 2014;42:1756-1765.
20.
Bagshaw SM, Bellomo R: Early diagnosis of acute kidney injury. Curr Opin Crit Care 2007;13:638-644.
21.
Khwaja A: KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 2012;120:c179-c184.
22.
Piccinni P, Cruz DN, Gramaticopolo S, Garzotto F, Dal Santo M, Aneloni G, et al: Prospective multicenter study on epidemiology of acute kidney injury in the ICU: a critical care nephrology Italian collaborative effort (NEFROINT). Minerva Anestesiol 2011;77:1072-1083.
23.
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group; in Critical Care. London, England, 2004, pp R204-R212.
24.
Walsh JF, Reznikoff M: Bootstrapping: a tool for clinical research. J Clin Psychol 1990;46:928-930.
25.
Bouchard J, Soroko SB, Chertow GM, Himmelfarb J, Ikizler TA, Paganini EP, et al: Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int 2009;76:422-427.
26.
Schneider AG, Uchino S, Bellomo R: Severe acute kidney injury not treated with renal replacement therapy: characteristics and outcome. Nephrol Dial Transplant 2012;27:947-952.
27.
Chou YH, Huang TM, Wu VC, Wang CY, Shiao CC, Lai CF, et al: Impact of timing of renal replacement therapy initiation on outcome of septic acute kidney injury. Crit Care 2011;15:R134.
28.
Cioffi WG, Ashikaga T, Gamelli RL: Probability of surviving postoperative acute renal failure. Development of a prognostic index. Ann Surg 1984;200:205-211.
29.
Yuasa S, Takahashi N, Shoji T, et al: A simple and early prognostic index for acute renal failure patients requiring renal replacement therapy. Artif Organs 1998;22:273-278.
30.
Bagshaw SM, Cruz DN, Gibney RT, Ronco C: A proposed algorithm for initiation of renal replacement therapy in adult critically ill patients. Crit Care 2009;13:317.
31.
Ostermann M, Dickie H, Barrett NA: Renal replacement therapy in critically ill patients with acute kidney injury - when to start. Nephrol Dial Transplant 2012;27:2242-2248.
32.
Thakar CV, Arrigain S, Worley S, Yared JP, Paganini EP: A clinical score to predict acute renal failure after cardiac surgery. J Am Soc Nephrol 2005;16:162-168.
33.
Mehta RH, Grab JD, O'Brien SM, Bridges CR, Gammie JS, Haan CK, et al: Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery. Circulation 2006;114:2208-2216; quiz 2208.
34.
Wijeysundera DN, Karkouti K, Dupuis JY: Derivation and validation of a simplified predictive index for renal replacement therapy after cardiac surgery. JAMA 2007;297:1801-1809.
35.
Vives M, Monedero P, Perez-Valdivieso JR, Garcia-Fernandez N, Lavilla J, Herreros J, et al: External validation and comparison of three scores to predict renal replacement therapy after cardiac surgery: a multicenter cohort. Int J Artif Organs 2011;34:329-338.
36.
Pipili C, Ioannidou S, Tripodaki ES, Parisi M, Douka E, Vasileiadis I, et al: Prediction of the renal replacement therapy requirement in mechanically ventilated critically ill patients by combining biomarkers for glomerular filtration and tubular damage. J Crit Care 2014;29:692.e7-e13.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.