Delay in the Initiation of Extra Renal Purification on the Morbi-Mortality of Patients with Acute Renal Aggression in the Surgical Resuscitation of Mulhouse Hospital

Abstract

<i>Introduction: </i>Acute renal failure (ARI) is a sudden onset of the partial or total inability of the kidney to eliminate the products of nitrogen catabolism and to maintain the hydro-electrolyte balance. It results in the installation of an acute uremic syndrome, made up of a constellation of biological and clinical abnormalities, the intensity of which directly defines the therapeutic urgency. The ideal moment to start an ERA remains debated, with studies with sometimes contradictory results. <i>Objective: </i>to determine the effect of the delay in initiation of the RE on the morbidity and mortality of patients in intensive care surgery in Mulhouse, in the context of severe ARI with multi-visceral involvement. <i>Materials and methods: </i>This is a retrospective single-center study, of the professional practice evaluation type, carried out in the surgical intensive care unit of the Groupe Hospitalier de la Région de Mulhouse Sud Alsace (GHRMSA) over a period of 12 months (March 2019 to February 2020). All patients aged at least 18 years and presenting with ARF were included in the study. Diagnosis and severity of renal injury was determined using the DIGO K score. The primary endpoint was mortality. <i>Results:</i> In 122 patients, the diagnosis of ARF was retained. Twenty-six of them benefited from an RRT and among which 18 for an early RRT and 8 for a late RRT. Baseline patient characteristics were similar in the 2 groups. Mortality was 50.0% in the two early RRT groups and 50.0% in the late RRT group, among the patients who received dialytic treatment with a statistically non-significant difference. <i>Conclusion:</i> This study did not show a difference in terms of mortality between the early RRT group and the late RRT group in patients with severe acute renal injury in intensive care. On the other hand, it notes a reduction in the duration of stay in intensive care as well as the duration of the EER in the early group.