• Hyung Jung Oh, Hyang Mo Koo, Fa Mee Doh, Jung Tak Park, Tae-Hyun Yoo, Shin-Wook Kang, Kwang Il Ko, Young Eun Kwon, Yung Ly Kim, Ki Heon Nam, and Seong Yeong An.
• Department of Internal Medicine, College of Medicine, Brain Korea 21, Severance Biomedical Science Institute, Yonsei University, Seoul, Korea.
• J Crit Care. 2013 Aug 1;28(4):379-88.

PurposeAlthough some studies have found that early initiation of continuous renal replacement therapy (CRRT) is associated with better prognosis, no consensus exists on the best timing to start CRRT. We investigated whether the timing of CRRT initiation was relevant to overall mortality and explored which factors at the time of CRRT initiation were associated with better outcomes in critically ill patients with acute kidney injury (AKI).Materials And MethodsA total of 361 patients who received CRRT for AKI between 2009 and 2011 were collected and divided into 2 groups based on the median blood urea nitrogen (BUN) levels or 6-hour urine output immediately before CRRT was started. The impact of the timing of CRRT initiation stratified by BUN concentration or urine output on 28-day all-cause mortality was compared between groups.ResultsWhen the timing of CRRT initiation was stratified by 6-hour urine output, 28-day all-cause mortality rates were significantly lower in the nonoliguric group compared with the oliguric group (P = .02). In contrast, clinical outcomes were not different between the low-BUN and the high-BUN groups (P = .30). Cox regression analysis revealed that 28-day all-cause mortality risk was significantly lower in the nonoliguric group stratified by 6-hour urine output, even after adjusting for age, sex, mean arterial pressure, Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and serum biomarkers (hazard ratio, 0.85; 95% confidence interval, 0.65-0.99; P = .04).ConclusionsUrine output but not BUN concentration was significantly associated with a better prognosis in critically ill patients with AKI requiring CRRT.Copyright © 2013 Elsevier Inc. All rights reserved.

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