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Acute kidney injury (AKI) is considered an independent factor for increase mortality, morbidity and hospital stay. Since 2012 that KDIGO propose the classification, we consider KDIGO 3 a critically ill patient, that, if the requirement for CRRT is met, the patient mostly is in ICU by then. In CRRT, renal recovery factors and predictors for the suspension of CRRT have not been well establish, for this reason we decided to create this study. If we can find renal recovery factors that would help us predict that the patient will return to the basal glomerular filtration rate previous to the CRRT or at least < 2 mg/dl of creatine compared to the measured in admission, we may help determine the prognosis of the patients.
Patients data was deidentified for statistical analysis. Frequencies and percentages were used to describe categorical variables. Normality of numerical variables were assessed using Kolmogorov-Smirnov test. For quantitative variables, central tendency and dispersion were reported. The comparison of means and medians were carried out with T-student and Wilcoxon for paired samples according to the distribution of the data. Categorical variables were compared using Pearson's Chi square tests or Fisher's exact tests. A logistic regression was performed and the prognostic performance for the prediction of recovery of renal function was determined using the area under the curve (AUC).
A total of 39 patients were analyzed (Table 1), divided into two groups, patients with renal recovery and non-renal recovery. Of the total n, 30 (77%) were men; mean age 66 (±13). 1 (2.6%) had CKD, 8 (21%) had heart disease. And 14 (36%) had systemic arterial hypertension. Of the renal recovery group, 5 (26%) had DM2, while 3 (15%) of the non-renal recovery group. In the renal recovery group, the days of CRRT were 3 (±3) and in the non-renal recovery group they were 6 (±7). Of the variables measured by groups (Table 2), BUN at 24 hours from the start of CRRT was 58 (± 26) with a significant p of 0.04 and urine output at 24 hours was 115 (± 237) with a significant p of 0.017, were positive to predict renal recovery. Logistic regression was performed, the model is show in table 3. However, albumin and creatinine were also analyzed with non-significant results.
The literature recognizes urinary output (UO) as an indicator of cessation of CRRT, as well as a probable predictor of renal recovery, however we have found that not only UO, but also BUN 24 hours after starting CRRT could be a predictor of renal recovery. More studies are necessary to evaluate predictive factors in critically ill patients such as the ones in the intensive care unit, who have developed AKI KDIGO 3 with a requirement and indication for continuous renal replacement. Since these factors can impact not only the prognosis, but also the management and treatment, further studies are required.