ABSTRACTS from 16th International COnference on ... - CRRT Online

<strong>ABSTRACTS</strong> FROM 17 TH INTERNATIONAL CONFERENCE ON CRRT,
SAN DIEGO, FEB 14-17, 2012
saline + 2meq of NaCl). After an
additional two hours, the sodium fell
further to 167mmol/L, and replacement
fluids were adjusted to contain
184meq/L of sodium, the dialysate was
modified to contain a sodium of
172meq/L, and the patient was given
2mL of 3% saline. The serum sodium
then increased to 172mmol/L and
remained 172-174 for the next 1 hour.
The sodium content of the dialysate and
replacement fluids were adjusted down
on a daily basis in order to reduce the
serum sodium slowly over the next 7
days. Intracranial pressure and cerebral
perfusion pressures were monitored
continuously and remained within target.
On day 7 of CRRT, serum sodium had
reached 147, however she had no
neurologic improvement and the
decision was made by the family to
withdrawal care. While ultimately the
patient’s underlying neurologic injury
was devastating, this case demonstrates
that in the setting of severe
hypernatremia, sodium can be safely
reduced in a controlled manner with
custom-made hypertonic dialysate and
replacement solutions.
9. Clinical parameters to determine
the optimal timing of CRRT in
critically ill patients with acute
kidney injury
Dong Ki Kim, Yong Chul Kim, Hajeong
Lee, Yon Su Kim, Suhnggwon Kim,
Sejoong Kim
Department of Internal Medicine, Seoul
National University Hospital,
Department of Internal Medicine, Seoul
National University Bundang Hospital
Purpose: The aim of this study was to
evaluate the clinical parameters to
determine the optimal time for
continuous renal replacement therapy
(CRRT) in critically ill patients with
severe acute kidney injury (AKI).
Methods. A single center retrospective
study was performed using data <strong>from</strong>
166 AKI patients who received CRRT in
intensive care unit (ICU) between
October 27 and January 21. We
compared mortality rate at 9 days after
the initiation of CRRT, ICU-free and
CRRT-free days between “early CRRT”
and “late CRRT” groups stratified by
blood urea nitrogen (BUN), serum
creatinine, urine output and RIFLE
criteria. Results: The 9-day mortality
rate was significantly lower in the early
group compared with the late group
when stratified by median value of BUN
at the start of CRRT and mean hourly
urine output during 6 h, 12 h, and 24 h
before CRRT. In addition, the 9-day
mortality rate was also significantly
lower in patients who received CRRT in
the “injury” stage of RIFLE criteria
compared with those in “failure” or
“loss” stage. ICU-free and CRRT-free
days during the first 28 days were
significantly longer in the early group
when stratified by median level of BUN.
However, in terms of creatinine, ICUfree
and CRRT-free days were
significantly shorter in the early group
compared with the late group. CRRTfree
days during the first 28 days were
also longer in early group stratified by
median value of mean hourly urine
output during 6 h, 12 h before CRRT.
After adjusting for covariates, 9-day
mortality was independently lower in the
early group defined by median level of
BUN (OR=1.65 (1.1-2.47), p=.15) and
mean hourly urine output during 12h
before CRRT (OR=1.56 (1.5-2.33),
p=.27). Conclusion: Our data suggest
that early CRRT may have a survival
benefit in critically ill patients with
severe AKI, and BUN and urine output
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