Early continuous renal replacement therapy in septic acute kidney injury could be defined by its initiation within 24 hours of vasopressor infusion☆,☆☆

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Purpose:The optimal timing for the initiation of early continuous renal replacement therapy (CRRT) is uncertain and requires a practically feasible definition with acceptable evidence.Materials and methods:We investigated the clinical impacts of 3-time interval parameters on the morbidity and mortality of 177 patients with septic shock–induced acute kidney injury: (1) time from vasopressor initiation to CRRT initiation (Tvaso-CRRT), (2) time from intensive care unit (ICU) admission to CRRT initation (TICU-CRRT), and (3) time from endotracheal intubation to CRRT initiation (Tendo-CRRT).Results:The proportion of the patients with Tvaso-CRRT less than 24 h (median, 14 h, interquartile range [IQR], 5–30 h) was significantly higher in the survival group than in the non-survival group (84.3% vs. 58.5%, p < 0.001). Tvaso-CRRT less than 24 h and Sequential Organ Failure Assessment score were independent factors associated with 28-day mortality and 90-day mortality. TICU-CRRT (median, 17 h, IQR, 5–72 h) and Tendo-CRRT (median, 13 h, IQR, 4–48 h) were significantly correlated with both the length of ICU stay (p < 0.001) and mechanical ventilation duration (p < 0.001), but not mortality.Conclusions:Considering the possible therapeutic measurement by physician on the basis of the results in this study, early CRRT could be defined by a Tvaso-CRRT less than 24 h.HighlightsThe optimal timing of RRT initiation is controversial.We found that CRRT initiation from the time of vasopressor infusion was associated with improved survival in septic shock-induced AKI patients.We suggest that early CRRT in septic AKI could be defined by its initiation within 24 hours of vasopressor treatment.

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