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KMID : 0359920090280040295
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Korean Journal of Nephrology
2009 Volume.28 No. 4 p.295 ~ p.301
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Renal Recovery from Severe Acute Kidney Injury Requiring Renal Replacement Therapy
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Choi Kyung-A
Kwon Jeong-Ah
Kim Young-Hoon
Lee Yu-Ji
Oh Ha-Young
Kim Dae-Joong
Kim Yoon-Goo
Huh Woo-Seong
Lee Jung-Eun
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Abstract
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Purpose: Acute tubular necrosis (ATN) is a serious complication in critically ill patients. This study investigated the renal outcome of severe ATN requiring RRT and prognostic factors for renal recovery.
Methods: Between January 2000 and May 2008, surviving patients with presumed ATN requiring dialysis were analyzed retrospectively. Patients with pre-existing chronic kidney disease and other causes of ARF rather than ATN were excluded. Primary outcomes were complete renal recovery (CR) and dialysis withdrawal. CR was defined as a return to basal serum creatinine level or creatinine <1.5 mg/dL (male) or <1.3 mg/dL (female) without dialysis.
Results: Of one hundred twenty two patients, 79 (65%) patients were male. The mean age was 54±16 years and 87 patients (71%) received continuous renal replacement therapy. 55% had ischemic ATN, 29% had septic ATN, and 16% had nephrotoxic ATN. Mean duration of dialysis was 12 (6-29) days. Dialysis withdrawal rate at 30 days and at 60 days after initiation of dialysis were 51% and 77 %, respectively. CR at 60 days after initiation was 50%. Multivariate analysis revealed that older age (per year, Hazard ratio (HR)=0.981, 95% Confidence interval (CI) 0.963 to 0.999), ischemic ATN (vs. toxic ATN, HR=0.481, 95% CI 0.238 to 0.974),and longer duration of oliguria (per day, HR=0.979, 95 % CI 0.962 to 0.996) were independent prognostic factors of renal recovery.
Conclusion: Young age and short duration of oliguria were favorable factors for renal recovery from ATN requiring dialysis. The cause of ATN might be also an independent prognostic factor.
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KEYWORD
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Acute renal failure, ARF, Renal tubule necrosis, Renal replacement therapy, Prognostic
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