The American Journal of Surgery
Volume 198, Issue 3 , Pages 325-332, September 2009

The 90-day mortality and the subsequent renal recovery in critically ill surgical patients requiring acute renal replacement therapy

  • Yu-Feng Lin, M.D.

      Affiliations

    • Department of Nephrology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan, and National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
    • ,
  • Wen-Je Ko, M.D., Ph.D.

      Affiliations

    • Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan, and National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
    • ,
  • Tzong-Shinn Chu, M.D., Ph.D.

      Affiliations

    • Department of Nephrology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan, and National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
    • ,
  • Yih-Sharng Chen, M.D., Ph.D.

      Affiliations

    • Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan, and National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
    • ,
  • Vin-Cent Wu, M.D.

      Affiliations

    • Department of Nephrology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan, and National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
    • ,
  • Yung-Ming Chen, M.D., Ph.D.

      Affiliations

    • Department of Nephrology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan, and National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
    • ,
  • Ming-Shiou Wu, M.D., Ph.D.

      Affiliations

    • Department of Nephrology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan, and National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
    • ,
  • Yung-Wei Chen, M.D.

      Affiliations

    • Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan, and National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
    • ,
  • Ching-Wei Tsai, M.D.

      Affiliations

    • Department of Nephrology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan, and National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
    • ,
  • Chih-Chung Shiao, M.D.

      Affiliations

    • Department of Nephrology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan, and National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
    • ,
  • Wen-Yi Li, M.D.

      Affiliations

    • Department of Nephrology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan, and National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
    • ,
  • Fu-Chang Hu, M.S., Sc.D.

      Affiliations

    • National Center of Excellence for General Clinical Trials and Research, National Taiwan University, College of Public Health, Taipei, Taiwan
    • ,
  • Pi-Ru Tsai, R.N.

      Affiliations

    • Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan, and National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
    • ,
  • Tun-Jun Tsai, M.D., Ph.D.

      Affiliations

    • Department of Nephrology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan, and National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
    • ,
  • Kwan-Dun Wu, M.D., Ph.D.

      Affiliations

    • Department of Nephrology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan, and National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
    • Corresponding Author InformationCorresponding author. Tel.: +886-2-2312-3456; fax: +886-2-2393-4176
    • ,
  • The NSARF Study Group

Received 6 September 2008; received in revised form 26 October 2008

Abstract 

Background

Particular attention should be paid to postoperative patients that suffer from severe acute kidney injury (AKI) requiring renal replacement therapy (RRT).

Methods

This multicenter prospective observational study included 342 patients with postoperative AKI requiring RRT from January 2002 to December 2006.

Results

There were 137 (40%) survivors at 90 days after the commencement of RRT. Independent predictors of 90-day mortality were older age, presence of sepsis, status post–cardiopulmonary resuscitation, necessity of continuous renal replacement therapy (CRRT), requirement of total parenteral nutrition, lower body mass index, higher Sequential Organ Failure Assessment score, and higher serum lactate level at the commencement of RRT. Further analysis among the survivors showed that lower serum creatinine at intensive care unit admission, lower Simplified Acute Physiology Score II and inotropic equivalent score at the commencement of RRT, and using CRRT were independent predictors for subsequent renal recovery.

Conclusions

The development of AKI requiring RRT in postoperative critical patients represents a substantial risk for mortality and morbidity.

Keywords: Major operation, Acute kidney injury, Renal recovery, Renal replacement therapy, Intensive care

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 Supported by the Improving Dialysis Quality Research Funds, Ta-Tung Kidney Foundation National Taiwan University Hospital Yun-Lin branch (grant no. 98.X006), and Taiwan National Science Council (grant no. NSC 98-2314-B-002-108).

PII: S0002-9610(09)00005-1

doi:10.1016/j.amjsurg.2008.10.021

The American Journal of Surgery
Volume 198, Issue 3 , Pages 325-332, September 2009

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