| Renal Recovery from Severe Acute Kidney Injury Requiring Renal Replacement Therapy |
| Kyung A Choi, M.D., Jeong-Ah Kwon, M.D., Young-Hoon Kim, M.D., Yu-Ji Lee, M.D., Ha Young Oh, M.D., Dae Joong Kim, M.D., Yoon-Goo Kim, M.D., Wooseong Huh, M.D. and Jung Eun Lee, M.D. |
| Department of Medicine, Sungkyunkwan University School of Medicine Samsung Medical Center, Seoul, Korea |
| 임상연구 : 투석이 필요했던 중증 급성 신손상 환자에서 신장기능의 예후 |
| 최경아, 권정아, 김영훈, 이유지, 오하영, 김대중, 김윤구, 허우성, 이정은 |
| 성균관대학교 의과대학 삼성서울병원 신장내과 |
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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. |
| Key Words:
Acute renal failure (ARF), Renal tubule necrosis, Renal replacement therapy, Prognostic |
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