Does renal replacement therapy increase mortality in the ICU.docVIP

Pesta?a Critical Care 2011,15:415 /content/15/2/415 LET TER Does renal replacement therapy increase mortality in the ICU? David Pesta?a* See related research by Elseviers et al., /content/14/6/R221 Renal replacement therapy (RRT) is associated with remained higher in RRT patients. In a multivariate potential risks such as hypotension, catheter-related analysis in septic shock patients, however, we observed complications, hemorrhage and blood–extracorporeal that both severity scores are not related to mortality, circuit interactions. Several studies, however, have shown that early RRT in acute kidney injury (AKI) is associated contrary to the maximum Sequential Organ Failure Assessment scor e decision of starting RRT in with a better outcome in intensive care unit (ICU) many patients during their ICU stay may have been patients [1-3]. related to evolving factors not included in the analysis A recent retrospective study published in Critical Care (worsening severity, overload, progressing hypoxemia, has questioned the use of RRT in critically ill patients, and so forth), which a? ect mortality but are not detected including those with severe AKI [4]. Compared with in the initial snapshot assessment. For instance, it is conservative treatment, RRT patients showed a higher inconceivable that anuric patients did not receive RRT. mortality e indication for RRT was at the discretion of On the other hand, the use of RRT in some patients with mild renal impairment may have increased morbidity. e study underlines the idea that RRT is not necessary the physician, and patients receiving RRT presented higher severity and renal impairment scores. After multi- variate analysis correcting for severity of illness (Acute in many patients presenting