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Serum urea concentration is probably not related to outcome in ICU patients with AKI and renal replacement therapy

Wouter De Corte UGent, Raymond Vanholder UGent, Annemieke Dhondt UGent, Jan De Waele UGent, Johan Decruyenaere UGent, CHRISTIAN DANNEELS UGent, STEFAAN CLAUS UGent and Eric Hoste UGent (2011) NEPHROLOGY DIALYSIS TRANSPLANTATION. 26(10). p.3211-3218
abstract
Background. Acute kidney injury (AKI) is a common complication in patients admitted to the intensive care unit (ICU). Among other variables, serum urea concentrations are recommended for timing of initiation of renal replacement therapy (RRT). The aim of this study was to evaluate whether serum urea concentration or different serum urea concentration cutoffs as recommended in the literature were associated with in-hospital mortality at time of initiation of RRT for AKI. Methods. This is a retrospective single-centre study during a 3-year period (2004-07), in a 44-bed tertiary care centre ICU of adult AKI patients who were treated with RRT. Results. Three hundred and two patients were included: 68.9% male, median age 65 years and an APACHE II score of 21. The overall in-hospital mortality was 57.9%. Non-survivors were older (67 versus 64 years, P = 0.016) and had a higher APACHE II score (22 versus 20, P < 0.001). At time of initiation of RRT, they were more severely ill and had a lower serum urea concentration compared to survivors (130 versus 141 mg/dL, P = 0.038). Serum urea concentration, as well as the different historical serum urea concentration cut-offs had low area under the curves for the receiver operating characteristic curve for prediction of mortality. In multivariate analysis, age, and at time of initiation of RRT, potassium, SOFA score with exclusion of points for AKI and RIFLE class were associated with mortality, but serum urea concentration and the different cut-offs were not. Conclusions. This retrospective study suggests that serum urea concentration and serum urea concentration cut-offs at time of initiation of RRT have no predictive value for in-hospital mortality in ICU patients with AKI.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
critical care, renal replacement therapy, in-hospital mortality, acute kidney injury, serum urea concentration, CRITICALLY-ILL PATIENTS, ACUTE KIDNEY INJURY, RIFLE CRITERIA, FAILURE, DIALYSIS, CLASSIFICATION, EPIDEMIOLOGY, INITIATION, MORTALITY, HEMOFILTRATION
journal title
NEPHROLOGY DIALYSIS TRANSPLANTATION
Nephrol. Dial. Transplant.
volume
26
issue
10
pages
3211 - 3218
Web of Science type
Article
Web of Science id
000296349200026
JCR category
UROLOGY & NEPHROLOGY
JCR impact factor
3.396 (2011)
JCR rank
15/72 (2011)
JCR quartile
1 (2011)
ISSN
0931-0509
DOI
10.1093/ndt/gfq840
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
1978890
handle
http://hdl.handle.net/1854/LU-1978890
date created
2012-01-05 14:14:16
date last changed
2012-01-09 15:45:24
@article{1978890,
  abstract     = {Background. Acute kidney injury (AKI) is a common complication in patients admitted to the intensive care unit (ICU). Among other variables, serum urea concentrations are recommended for timing of initiation of renal replacement therapy (RRT). The aim of this study was to evaluate whether serum urea concentration or different serum urea concentration cutoffs as recommended in the literature were associated with in-hospital mortality at time of initiation of RRT for AKI. 
Methods. This is a retrospective single-centre study during a 3-year period (2004-07), in a 44-bed tertiary care centre ICU of adult AKI patients who were treated with RRT. 
Results. Three hundred and two patients were included: 68.9\% male, median age 65 years and an APACHE II score of 21. The overall in-hospital mortality was 57.9\%. Non-survivors were older (67 versus 64 years, P = 0.016) and had a higher APACHE II score (22 versus 20, P {\textlangle} 0.001). At time of initiation of RRT, they were more severely ill and had a lower serum urea concentration compared to survivors (130 versus 141 mg/dL, P = 0.038). Serum urea concentration, as well as the different historical serum urea concentration cut-offs had low area under the curves for the receiver operating characteristic curve for prediction of mortality. In multivariate analysis, age, and at time of initiation of RRT, potassium, SOFA score with exclusion of points for AKI and RIFLE class were associated with mortality, but serum urea concentration and the different cut-offs were not. 
Conclusions. This retrospective study suggests that serum urea concentration and serum urea concentration cut-offs at time of initiation of RRT have no predictive value for in-hospital mortality in ICU patients with AKI.},
  author       = {De Corte, Wouter and Vanholder, Raymond and Dhondt, Annemieke and De Waele, Jan and Decruyenaere, Johan and DANNEELS, CHRISTIAN and CLAUS, STEFAAN and Hoste, Eric},
  issn         = {0931-0509},
  journal      = {NEPHROLOGY DIALYSIS TRANSPLANTATION},
  keyword      = {critical care,renal replacement therapy,in-hospital mortality,acute kidney injury,serum urea concentration,CRITICALLY-ILL PATIENTS,ACUTE KIDNEY INJURY,RIFLE CRITERIA,FAILURE,DIALYSIS,CLASSIFICATION,EPIDEMIOLOGY,INITIATION,MORTALITY,HEMOFILTRATION},
  language     = {eng},
  number       = {10},
  pages        = {3211--3218},
  title        = {Serum urea concentration is probably not related to outcome in ICU patients with AKI and renal replacement therapy},
  url          = {http://dx.doi.org/10.1093/ndt/gfq840},
  volume       = {26},
  year         = {2011},
}

Chicago
De Corte, Wouter, Raymond Vanholder, Annemieke Dhondt, Jan De Waele, Johan Decruyenaere, CHRISTIAN DANNEELS, STEFAAN CLAUS, and Eric Hoste. 2011. “Serum Urea Concentration Is Probably Not Related to Outcome in ICU Patients with AKI and Renal Replacement Therapy.” Nephrology Dialysis Transplantation 26 (10): 3211–3218.
APA
De Corte, Wouter, Vanholder, R., Dhondt, A., De Waele, J., Decruyenaere, J., DANNEELS, C., CLAUS, S., et al. (2011). Serum urea concentration is probably not related to outcome in ICU patients with AKI and renal replacement therapy. NEPHROLOGY DIALYSIS TRANSPLANTATION, 26(10), 3211–3218.
Vancouver
1.
De Corte W, Vanholder R, Dhondt A, De Waele J, Decruyenaere J, DANNEELS C, et al. Serum urea concentration is probably not related to outcome in ICU patients with AKI and renal replacement therapy. NEPHROLOGY DIALYSIS TRANSPLANTATION. 2011;26(10):3211–8.
MLA
De Corte, Wouter, Raymond Vanholder, Annemieke Dhondt, et al. “Serum Urea Concentration Is Probably Not Related to Outcome in ICU Patients with AKI and Renal Replacement Therapy.” NEPHROLOGY DIALYSIS TRANSPLANTATION 26.10 (2011): 3211–3218. Print.