Continuous renal replacement therapy in intensive care: When is the optimal timing?

Introduction: Acute kidney injury is one of the most widespread problems in critical patients in intensive care. It leads to severe morbidity and mortality. Although the indications for emergency dialysis are well known, the timing for initiating CRRT in the critical patient is still unclear. This study examines the effect on mortality of early CRRT by retrospectively scanning critical patients who received CRRT in intensive care. Material and Method: Demographic, clinical, and laboratory data were recorded by retrospectively scanning patients aged over 18, with no previously known chronic kidney disease, and receiving only CRRT, who were treated in intensive care over a one-year period. The patients were divided into two groups, an early group consisting of KDIGO stages 1 and 2, and a late group consisting of KDIGO stage 3. These were than examined in terms of 28-day mortality. Results: Forty-eight patients with a mean age of 65.94±19.61 years were included in the study. Twenty-eight (58.3%) patients were men. Cardiovascular diseases were the most frequent diagnoses, in 16 (33.3%) patients, and comorbidity was detected in 32 (66.7%). SOFA, blood urea nitrogen, creatinine, and procalcitonin values differed between the groups, but no difference was observed in 28-day mortality. Conclusion: The study results showed that early or late application of CRRT has no positive effect on survival, but further randomized studies on the subject are now needed.