Korean J Neurotrauma.  2016 Oct;12(2):89-93. 10.13004/kjnt.2016.12.2.89.

Continuous Renal Replacement Therapy for Acute Renal Failure in Patients with Traumatic Brain Injury

Affiliations
  • 1Department of Neurosurgery, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea. nsksh@ajou.ac.kr
  • 2Department of Neurosurgery, Winjin Green Hospital, Seoul, Korea.

Abstract


OBJECTIVE
The purpose of this study was to investigate the impact of continuous renal replacement therapy (CRRT) on survival and relevant factors in patients who underwent CRRT after traumatic brain injury (TBI).
METHODS
We retrospectively reviewed the laboratory, clinical, and radiological data of 29 patients who underwent CRRT among 1,190 TBI patients treated at our institution between April 2011 and June 2015. There were 20 men and 9 women, and the mean age was 60.2 years. The mean initial Glasgow Coma Scale score was 9.2, and the mean injury severity score was 24. Kaplan-Meier method and Cox regression were used for analysis of survival and relevant factors.
RESULTS
The actuarial median survival time of the 29 patients was 163 days (range, 3-317). Among the above 29 patients, 22 died with a median survival time of 8 days (range, 3-55). The causes of death were TBI-related in 8, sepsis due to pneumonia or acute respiratory distress syndrome (ARDS) in 4, and multi-organ failure in 10. Among the various factors, urine quantity of more than 500 mL for 24-hours before receiving CRRT was a significant and favorable factor for survival in the multivariate analysis (p=0.026).
CONCLUSION
According to our results, we suggest that early intervention with CRRT may be beneficial in the treatment of TBI patients with impending acute renal failure (ARF). To define the therapeutic advantages of early CRRT in the TBI patients with ARF, a well-designed and controlled study with more cases is required.

Keyword

Brain injuries; Acute kidney injury; Renal replacement therapy; Intracranial pressure

MeSH Terms

Acute Kidney Injury*
Brain Injuries*
Cause of Death
Early Intervention (Education)
Female
Glasgow Coma Scale
Humans
Injury Severity Score
Intracranial Pressure
Male
Methods
Multivariate Analysis
Pneumonia
Renal Replacement Therapy*
Respiratory Distress Syndrome, Adult
Retrospective Studies
Sepsis

Figure

  • FIGURE 1 Kaplan-Meier curves for the patients underwent continuous renal replacement therapy (CRRT) after traumatic brain injury. (A) Overall survival. (B) Twenty four hours urine output before receiving CRRT. (C) Subdural hematoma. (D) Injury severity score. SDH: subdural hematoma.


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