Timing of Kidney Replacement Therapy Initiation in Patients With Septic Shock: A Descriptive Study Using a Japanese Inpatient Database.

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Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy Pub Date : 2026-06-01 Epub Date: 2026-03-19 DOI:10.1002/1744-9987.70134

Ken-Ichi Kano, Kayoko Mizuno, Hiroki Shimada, Chikashi Takeda, Koji Kawakami

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Abstract

Background: Kidney Replacement Therapy (KRT) timing in septic shock remains debated. We assessed temporal trends in KRT initiation and outcomes in Japan.

Methods: Using a nationwide EMR database (2016-2023), we included adults (≥ 20 years) with septic shock admitted to the intensive care unit (ICU) or high-dependency care unit (HDU) on day 0 who received KRT. Outcomes were KRT timing by hospital day, in-hospital mortality, and KRT dependency at discharge; sensitivity analyses used consistently reporting hospitals.

Results: Among 688 hospitalizations (median age 74 years), KRT initiation shifted later, with day ≥ 2 initiation reaching 38.5% in 2023. In 2022, mortality was 54.3% (n = 25), and KRT dependency was 43.5% (n = 20). Patterns were similar across modalities/settings.

Conclusions: KRT initiation shifted toward later timing after 2022. Studies with granular severity and indication data are needed to clarify drivers of variation and outcomes.

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脓毒性休克患者开始肾脏替代治疗的时机：一项使用日本住院患者数据库的描述性研究。

背景：肾脏替代治疗（KRT）在感染性休克中的时机仍有争议。我们评估了日本KRT启动和结果的时间趋势。方法：使用全国EMR数据库（2016-2023），我们纳入了第0天入住重症监护病房（ICU）或高依赖护理病房（HDU）并接受KRT的感染性休克成人（≥20岁）。结果是KRT的住院时间、住院死亡率和出院时的KRT依赖性；敏感性分析采用一致报告的医院。结果：在688例住院患者（中位年龄74岁）中，KRT起始时间延迟，2023年开始≥2天的患者达到38.5%。2022年，死亡率为54.3% (n = 25)， KRT依赖性为43.5% （n = 20）。不同模式/设置的模式相似。结论：KRT启动时间在2022年之后转向了较晚的时间。需要粒度严重程度和适应症数据的研究来阐明变异和结果的驱动因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy

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