Effect Of Duration Of Continuous Renal Replacement Therapy On The Condition And Regression Of Acute Kidney Injury In Sepsis

Objective: Continuous renal replacement therapy(CRRT)has been shown to be effective in patients with septic acute kidney injury(SA-AKI),but the timing of treatment is still controversial.Therefore,this study analyses the timing of CRRT on the condition and outcome of patients with acute kidney injury in sepsis,and investigates the appropriate timing of CRRT for patients with SA-AKI patients in clinical practice.METHODS: The clinical data of hospitalized SA-AKI patients who underwent CRRT in the intensive care units of the First Affiliated Hospital of Nanchang University from January 1,2018 to January 1,2023 were included,and the patients were divided into acute kidney injury(AKI)groups according to the 2012 Kidney Disease: Improving Global Outcomes(KDIGO)(The patients were divided into AKI stage I group,AKI stage II group and AKI stage III group according to the diagnostic and staging criteria of acute kidney injury(AKI)of the 2012 Kidney Disease Improving Global Outcomes(KDIGO),and the AKI stage II group was divided into early(within 12h),intermediate(within 12h-24h)and late(>24h)groups according to the time to CRRT after the diagnosis of AKI stage II.The general clinical data and clinical indicators(site of infection,SOFA score,APACHE II score,urine volume,creatinine SCr,mean arterial pressure,dose of vasoactive drugs)and outcome indicators(time to CRRT,ICU stay,total hospital stay,in-hospital morbidity and mortality)were compared and analyzed before and after CRRT treatment in each group to comprehensively investigate the effect of CRRT treatment timing on the condition and regression of SA-AKI patients.Results: A total of 380 patients with SA-AKI were included,and the source of infection was mainly pulmonary infection,including 113 patients in the AKI stage I group,121 patients in the AKI stage II group and 146 patients in the AKI stage III group;the patients were divided into 73 patients in the early stage group,32 patients in the middle stage group and 16 patients in the late stage group according to the time of CRRT after the diagnosis of AKI stage II.The mean age of patients in the AKI stage I group was significantly higher than that in the AKI stage III group(p<0.05),and the creatinine level in the AKI stage I group was significantly lower and the duration of CRRT was significantly shorter than that in the other groups(p<0.05),suggesting that CRRT in AKI stage I may reduce renal replacement therapy dependence and facilitate renal function recovery effects.The creatinine was significantly lower in the early and intermediate groups after CRRT than in the late group(p<0.05),suggesting that CRRT performed within 24 h after AKI stage II may may facilitate improved recovery of kidney function.Applying Cox regression analysis with hospitalization outcome as survival or death as survival status variable and ICU length of stay as survival time variable,respectively,it was concluded that increasing age and elevated mean arterial pressure after CRRT were independent protective factors for good prognosis(p<0.05)and elevated APACHE II score before and after CRRT were independent risk factors for good prognosis(p<0.05);using total hospitalization time as survival time variable,increasing age,increased urine output before CRRT,increased SOFA score,and increased mean arterial pressure after CRRT were independent protective factors for good prognosis(p<0.05),and increased mean arterial pressure before CRRT,increased dose of vasoactive drugs,and increased APACHE II score were independent risk factors for good prognosis(p<0.05).Conclusion: 1.Both APACHE II score and SOFA score can be used to assess the condition of SA-AKI patients and help choose the right time for CRRT.2.Early CRRT may improve the hemodynamic status and disease regression when SA-AKI patients become hemodynamically unstable.3.CRRT within AKI I and 24 h after AKI II in SA-AKI patients may reduce renal replacement therapy dependence,facilitate renal function recovery,and improve disease regression.