Cargando…

Risk factors for mortality in patients with acute kidney injury and hypotension treated with continuous veno-venous hemodiafiltration

BACKGROUND: Continuous veno-venous hemodiafiltration (CVVHDF) is a preferred treatment modality in hemodynamically unstable acute kidney injury (AKI) patients, because it has advantages over intermittent dialysis in terms of hemodynamic stability. However, this patient group still shows a significan...

Descripción completa

Detalles Bibliográficos
Autores principales: Oh, In Myung, Lee, Jang Han, Yoo, Kyoung Hwa, Park, Ji Eun, Oh, Dong Hyun, Kim, Mi Jung, Ha, Seung Hea, Lee, Gi Jong, Kim, Jung Hee, Jung, Yoon Chul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4716103/
https://www.ncbi.nlm.nih.gov/pubmed/26889424
http://dx.doi.org/10.1016/j.krcp.2012.09.005
_version_ 1782410500300079104
author Oh, In Myung
Lee, Jang Han
Yoo, Kyoung Hwa
Park, Ji Eun
Oh, Dong Hyun
Kim, Mi Jung
Ha, Seung Hea
Lee, Gi Jong
Kim, Jung Hee
Jung, Yoon Chul
author_facet Oh, In Myung
Lee, Jang Han
Yoo, Kyoung Hwa
Park, Ji Eun
Oh, Dong Hyun
Kim, Mi Jung
Ha, Seung Hea
Lee, Gi Jong
Kim, Jung Hee
Jung, Yoon Chul
author_sort Oh, In Myung
collection PubMed
description BACKGROUND: Continuous veno-venous hemodiafiltration (CVVHDF) is a preferred treatment modality in hemodynamically unstable acute kidney injury (AKI) patients, because it has advantages over intermittent dialysis in terms of hemodynamic stability. However, this patient group still shows a significantly high mortality rate. To aid in the management of these high-risk patients, we evaluated the risk factors for mortality in CVVHDF-treated hypotensive AKI patients. METHODS: We studied 67 patients with AKI and hypotension who were treated with CVVHDF from February 2008 to August 2010. We reviewed patient characteristics and laboratory parameters to evaluate the risk factors for 90-day mortality. RESULTS: Of the 67 enrolled patients (male:female=42:25; mean age=69±14 years), 18 (27%) survived until 90 days after the initiation of CVVHDF. There was no significant difference in survival rates according to the etiology of AKI [hypovolemic shock 2/10 (20%), cardiogenic shock 4/20 (20%), septic shock 12/37 (32%)]. Univariate analysis did show significant differences between survivors and non-survivors in the frequency of ventilator use (44% vs. 76%, respectively; P=0.02), APACHE II score (29±7 vs. 34±7, respectively; P=0.01), SOFA score (11±4 vs. 13±4, respectively; P=0.03), blood pH (7.3±0.1 vs. 7.2±0.1, respectively; P=0.03), and rate of urine output <500 mL for 12 hours (50% vs. 80%, respectively; P=0.03). A multivariate Cox proportional hazards model showed that a urine output<500 mL for 12 hours was the only significant risk factor for 90-day mortality following CVVHDF treatment (odds ratio=2.1, confidence interval=1.01–4.4, P=0.048). CONCLUSION: A urine output<500 mL for 12 hours before the initiation of CVVHDF is an independent risk factor for 90-day mortality in hypotensive AKI patients treated with CVVHDF.
format Online
Article
Text
id pubmed-4716103
institution National Center for Biotechnology Information
language English
publishDate 2012
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-47161032016-02-17 Risk factors for mortality in patients with acute kidney injury and hypotension treated with continuous veno-venous hemodiafiltration Oh, In Myung Lee, Jang Han Yoo, Kyoung Hwa Park, Ji Eun Oh, Dong Hyun Kim, Mi Jung Ha, Seung Hea Lee, Gi Jong Kim, Jung Hee Jung, Yoon Chul Kidney Res Clin Pract Orignal Article BACKGROUND: Continuous veno-venous hemodiafiltration (CVVHDF) is a preferred treatment modality in hemodynamically unstable acute kidney injury (AKI) patients, because it has advantages over intermittent dialysis in terms of hemodynamic stability. However, this patient group still shows a significantly high mortality rate. To aid in the management of these high-risk patients, we evaluated the risk factors for mortality in CVVHDF-treated hypotensive AKI patients. METHODS: We studied 67 patients with AKI and hypotension who were treated with CVVHDF from February 2008 to August 2010. We reviewed patient characteristics and laboratory parameters to evaluate the risk factors for 90-day mortality. RESULTS: Of the 67 enrolled patients (male:female=42:25; mean age=69±14 years), 18 (27%) survived until 90 days after the initiation of CVVHDF. There was no significant difference in survival rates according to the etiology of AKI [hypovolemic shock 2/10 (20%), cardiogenic shock 4/20 (20%), septic shock 12/37 (32%)]. Univariate analysis did show significant differences between survivors and non-survivors in the frequency of ventilator use (44% vs. 76%, respectively; P=0.02), APACHE II score (29±7 vs. 34±7, respectively; P=0.01), SOFA score (11±4 vs. 13±4, respectively; P=0.03), blood pH (7.3±0.1 vs. 7.2±0.1, respectively; P=0.03), and rate of urine output <500 mL for 12 hours (50% vs. 80%, respectively; P=0.03). A multivariate Cox proportional hazards model showed that a urine output<500 mL for 12 hours was the only significant risk factor for 90-day mortality following CVVHDF treatment (odds ratio=2.1, confidence interval=1.01–4.4, P=0.048). CONCLUSION: A urine output<500 mL for 12 hours before the initiation of CVVHDF is an independent risk factor for 90-day mortality in hypotensive AKI patients treated with CVVHDF. Elsevier 2012-12 2012-10-05 /pmc/articles/PMC4716103/ /pubmed/26889424 http://dx.doi.org/10.1016/j.krcp.2012.09.005 Text en © 2012. The Korean Society of Nephrology. Published by Elsevier. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Orignal Article
Oh, In Myung
Lee, Jang Han
Yoo, Kyoung Hwa
Park, Ji Eun
Oh, Dong Hyun
Kim, Mi Jung
Ha, Seung Hea
Lee, Gi Jong
Kim, Jung Hee
Jung, Yoon Chul
Risk factors for mortality in patients with acute kidney injury and hypotension treated with continuous veno-venous hemodiafiltration
title Risk factors for mortality in patients with acute kidney injury and hypotension treated with continuous veno-venous hemodiafiltration
title_full Risk factors for mortality in patients with acute kidney injury and hypotension treated with continuous veno-venous hemodiafiltration
title_fullStr Risk factors for mortality in patients with acute kidney injury and hypotension treated with continuous veno-venous hemodiafiltration
title_full_unstemmed Risk factors for mortality in patients with acute kidney injury and hypotension treated with continuous veno-venous hemodiafiltration
title_short Risk factors for mortality in patients with acute kidney injury and hypotension treated with continuous veno-venous hemodiafiltration
title_sort risk factors for mortality in patients with acute kidney injury and hypotension treated with continuous veno-venous hemodiafiltration
topic Orignal Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4716103/
https://www.ncbi.nlm.nih.gov/pubmed/26889424
http://dx.doi.org/10.1016/j.krcp.2012.09.005
work_keys_str_mv AT ohinmyung riskfactorsformortalityinpatientswithacutekidneyinjuryandhypotensiontreatedwithcontinuousvenovenoushemodiafiltration
AT leejanghan riskfactorsformortalityinpatientswithacutekidneyinjuryandhypotensiontreatedwithcontinuousvenovenoushemodiafiltration
AT yookyounghwa riskfactorsformortalityinpatientswithacutekidneyinjuryandhypotensiontreatedwithcontinuousvenovenoushemodiafiltration
AT parkjieun riskfactorsformortalityinpatientswithacutekidneyinjuryandhypotensiontreatedwithcontinuousvenovenoushemodiafiltration
AT ohdonghyun riskfactorsformortalityinpatientswithacutekidneyinjuryandhypotensiontreatedwithcontinuousvenovenoushemodiafiltration
AT kimmijung riskfactorsformortalityinpatientswithacutekidneyinjuryandhypotensiontreatedwithcontinuousvenovenoushemodiafiltration
AT haseunghea riskfactorsformortalityinpatientswithacutekidneyinjuryandhypotensiontreatedwithcontinuousvenovenoushemodiafiltration
AT leegijong riskfactorsformortalityinpatientswithacutekidneyinjuryandhypotensiontreatedwithcontinuousvenovenoushemodiafiltration
AT kimjunghee riskfactorsformortalityinpatientswithacutekidneyinjuryandhypotensiontreatedwithcontinuousvenovenoushemodiafiltration
AT jungyoonchul riskfactorsformortalityinpatientswithacutekidneyinjuryandhypotensiontreatedwithcontinuousvenovenoushemodiafiltration