• J Lin, X J Ji, A Y Wang, J F Liu, P Liu, M Zhang, Z L Qi, D C Guo, R Bellomo, S M Bagshaw, R Wald, M Gallagher, and M L Duan.
• Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, China.
• J Crit Care. 2021 Aug 1; 64: 226-236.

PurposeWe aimed to evaluate the association of early versus late initiation of Continuous renal replacement therapy (CRRT) with mortality in patients with fluid overload.MethodsThis was a retrospective cohort study of patients with fluid overload (FO) treated with CRRT due to severe acute kidney injury (AKI) between January 2015 and December 2017 in a mixed medical intensive care unit of a teaching hospital in Beijing, China. Patients were divided into early (≤15 h) and late (>15 h) groups based on the median time from ICU admission to CRRT initiation. The primary outcome was all-cause mortality at day 60. Multivariable Cox model analysis was used for analysis.ResultsThe study patients were male predominant (84/150) with a mean age of 64.8 ± 16.7 years. The median FO value before CRRT initiation was 10.1% [6.2-16.1%]. The 60-day mortality rates in the early vs the late CRRT groups were 53.9% and 73%, respectively. On multivariable Cox modelling, the late initiation of CRRT was independently associated with an increased risk of death at 60 days (HR 1.75, 95% CI 1.11-2.74, p = 0.015).ConclusionsEarly initiation of CRRT was independently associated with survival benefits in severe AKI patients with fluid overload.Copyright © 2021. Published by Elsevier Inc.

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