Evaluation of Outcomes After Early Versus Late Initiation of Continuous Renal Replacement Therapy in Adult Patients With Sepsis-Associated Acute Kidney Injury

Background and aim: Prospective studies comparing outcomes following early versus late initiation of continuous renal replacement therapy (CRRT), labeled as per Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, in patients with sepsis-associated acute kidney injury (S-AKI) are lacking. The aim was to compare the 28-day mortality rate, renal recovery rate, and length of stay in ICU and hospital among patients of S-AKI with early versus late institution of CRRT. Patients and methods: Sixty consenting adult patients (18-65 years) of S-AKI needing CRRT were screened. In the early CRRT group, it was instituted in KDIGO stage I AKI with complications (either raised serum potassium, metabolic acidosis, uremia, or acute pulmonary edema) or stage II. The late CRRT group was for patients with KDIGO stage III or stage II who could not have CRRT started within two hours. Results: The data from 32 patients were collected and analyzed in the study. Demographic parameters and illness severity were comparable between the early and late CRRT groups. The length of ICU stay, need for blood transfusion, renal recovery, and the requirement for RRT on day 28 were comparable between the two groups. The 28-day mortality rate in the early CRRT group was lower than that in the late CRRT group (4/25% versus 7/43.75%, p-value 0.048). Conclusion: Early initiation of CRRT (KDIGO stage I/II) in patients with S-AKI leads to lower 28-day mortality compared to those in whom CRRT was initiated at a late stage (III).