Early Versus Late Initiation of Renal Replacement Therapy Impacts Early Mortality in Diabetic Patients with Acute Kidney Injury After Cardiac Surgery

Abstract

There are limited data on the optimal time of renal replacement therapy (RRT) after cardiac surgery, and published results are controversial. In our study, an answer was sought to the question of the correct timing of RRT in diabetic patients with post-cardiac surgery acute kidney injury (AKI). Forty-four adult patients with DM who required postoperative RRT were included in our single-center prospective study. According to the time of onset of RRT, the patients were divided into two groups: those whose RRT was initiated with the early protocol (RRT started before conventional urgent indications developed) or the standard protocol (RRT started after at least one conventional urgent indication developed). The primary endpoint was in-hospital mortality; secondary endpoints were RRT duration, renal recovery, and ICU and hospital length of stay. A total of 54.5% of the 44 participants were female, while the mean age was 65 ± 9. Early RRT protocol was performed on 21(47.7%) and the standard protocol was performed on 23 (52.3%) patients. Twenty-three patients (52.3%) died during follow-up. Patient survival was found to be significantly higher in the group of patients who received the early RRT protocol, based on univariate analysis, binary regression analysis, Cox regression analysis, and log-rank analysis, compared to the standard protocol group (respectively, p < 0.001, p < 0.03, p < 0.01, and p < 0.001). It was found that RRT initiation with an early protocol was advantageous in terms of survival in the post-cardiac surgery AKI group of diabetic patients. We believe that the study results provide guidance on the follow-up of this group of patients.