Nattachai Srisawat1, Passisd Laoveeravat2, Ploynapas Limphunudom3, Nuttha Lumlertgul4, Sadudee Peerapornratana4, Khajohn Tiranathanagul4, Paweena Susantitaphong5, Kearkiat Praditpornsilpa5, Kriang Tungsanga5, Somchai Eiam-Ong5. 1. Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence center of Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; The Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Electronic address: drnattachai@yahoo.com. 2. Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence center of Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; The Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 3. Navamindradhiraj University, Bangkok, Thailand. 4. Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence center of Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand. 5. Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Abstract
PURPOSE: The optimal time and the parameter utilized for decision to initiate renal replacement therapy (RRT) in acute kidney injury (AKI) are still controversial. Recently, high levels of plasma NGAL (pNGAL) has been strongly correlated with poor AKI outcome. This is a feasibility study conducted to test whether early RRT initiation guided by pNGAL could improve AKI outcome. MATERIAL AND METHODS: The study comprised of triage trial and interventional trial running subsequently. As a guide for triage to RRT, we measured pNGAL at the enrollment time. Forty patients with pNGAL≥400ng/mL (high pNGAL group) were randomized to 'early' or 'standard' group. Patients with pNGAL<400ng/mL (n=20) were defined as low pNGAL group. RESULTS: The triggering pNGAL selected AKI patients with more severity of illness and worse clinical outcome. However, in high pNGAL group, early RRT did not result in different 28-day mortality from the standard group. The median numbers of day free from mechanical ventilation were significantly higher in the early RRT group. CONCLUSIONS: Our finding suggested that it was feasible to use pNGAL to triage severe AKI patients. However, early initiation of RRT in this high risk group did not affect the 28-day mortality.
RCT Entities:
PURPOSE: The optimal time and the parameter utilized for decision to initiate renal replacement therapy (RRT) in acute kidney injury (AKI) are still controversial. Recently, high levels of plasma NGAL (pNGAL) has been strongly correlated with poor AKI outcome. This is a feasibility study conducted to test whether early RRT initiation guided by pNGAL could improve AKI outcome. MATERIAL AND METHODS: The study comprised of triage trial and interventional trial running subsequently. As a guide for triage to RRT, we measured pNGAL at the enrollment time. Forty patients with pNGAL≥400ng/mL (high pNGAL group) were randomized to 'early' or 'standard' group. Patients with pNGAL<400ng/mL (n=20) were defined as low pNGAL group. RESULTS: The triggering pNGAL selected AKI patients with more severity of illness and worse clinical outcome. However, in high pNGAL group, early RRT did not result in different 28-day mortality from the standard group. The median numbers of day free from mechanical ventilation were significantly higher in the early RRT group. CONCLUSIONS: Our finding suggested that it was feasible to use pNGAL to triage severe AKI patients. However, early initiation of RRT in this high risk group did not affect the 28-day mortality.
Authors: Mark Andonovic; Richard Shemilt; Malcolm Sim; Jamie P Traynor; Martin Shaw; Patrick B Mark; Kathryn A Puxty Journal: J Intensive Care Soc Date: 2020-02-06
Authors: Sebastian J Klein; Anna K Brandtner; Georg F Lehner; Hanno Ulmer; Sean M Bagshaw; Christian J Wiedermann; Michael Joannidis Journal: Intensive Care Med Date: 2018-03-14 Impact factor: 17.440