Risk (R) 11%
Injury (I) 31.4%
Failure (F) 57.6%
Ventilazione meccanica 93.2%
Farmaci inotropi (≥3mcg/Kg/min) 84.5% Nutrizione Parenterale Totale e/o Enterale 100% APACHE II* score (range 7-44) 30.7 ± 6.1
SOFA** score (range 6-22) 13.7 ± 3
* Acute Physiology and Chronic Health Evaluation ** Sequential Organ Failure Assessment
Tab. VII: “Outcome”- Analisi statistica univariata (n = 266)
“Survivors” 37.1% (n=98) “Non-survivors” 62.9% (n=166)
41 Età 64.1 ± 12.4 66.2 ± 10.6 ns Cr inizio CRRT 3.7 ± 1.8 4.1 ± 1.9 ns BUN inizio CRRT 81.7 ± 35.6 88.8 ± 41.4 ns SOFA score * 12.5 ± 3 14.5 ± 2.8 p<0.0001 CV-SOFA-1 * 2.2 ± 1.2 2.4 ± 1.1 ns CV-SOFA-7 ** 1 ± 1.1 1.8 ± 1.1 p<0.0001 SOFAmax 13.5 ± 2.9 16.2 ± 3.2 p<0.0001 APACHE II score * 27.9 ± 5.9 32.4 ± 5.5 p<0.0001 * Inizio CRRT
42
Tab.VIII: “Outcome”renale - Analisi statistica univariata (n= 266)
“Recupero” 41.4% (n=110) “No recupero” 58.6% (n=156) Età 64.1 ± 12.3 66.6 ± 10.5 ns Cr inizio CRRT 4 ± 1.9 3.9 ± 1.8 ns BUN inizio CRRT 82 ± 37.3 88.9 ± 40.7 ns SOFA score * 12.6 ± 3 14.6 ± 2.8 p<0.0001 CV-SOFA-1 * 2.2 ± 1.1 2.4 ± 1.1 ns CV-SOFA-7 ** 1.2 ± 1.2 1.7 ± 1.2 p<0.01 SOFAmax 13.7 ± 3.2 16.2 ± 3 p<0.0001 APACHE II score* 28.5 ± 6 32.3 ± 5.6 p<0.0001 * Inizio CRRT
43
Tab. IX: Sopravvivenza in relazione ai diversi fattori prognostici (test del chi-quadro) (n =
266)
Fattore prognostico Presente Assente
Ittero 20.2% 44.9% p<0.0001 Coma 23% 51.6% p<0.0001 Sepsi 27.3% 49.6% p<0.0001 Oliguria 31.4% 52.1% p=0.003 Ventilazione meccanica 35.2% 64.7% p=0.02 Inotropi inizio CRRT 35.9% 42.5% ns Inotropi 48h CRRT 33.5% 48.3% p=0.047
44
Tab. X: Analisi multivariata (regressione logistica) (n = 266) Outcome
Variabile Coeff.(B) Odd Ratio p
CV-SOFA-7 ** 0.678 1.97/punto (CI 1.34-2.88) 0.001
Cr inizio CRRT 0.290 1.33/mg (CI 1.04-1.71) 0.024
Recupero funzione renale - 3.72 0.24 (CI 0.009-0.65) <0.0001
Recupero funzione renale
Variabile Coeff.(B) Odd Ratio p
Età - 0.44 0.96/anno (CI 0.93-0.98) 0.002
CV-SOFA-7 ** - 0.31 0.73/punto (CI 0.56-0.95) 0.019
Oliguria - 0.771 0.463 (CI 0.22-0.94) 0.034
Sepsi vs recup. tardivo* 1,564 4.779 (CI 1.61-14.13) 0.005 Cr inizio CRRT vs recup.tardivo* 0.371 1.45/mg (CI 1.09-1.92) 0.010
* Oltre 21 giorni
45
Tab. XI: Recupero della funzione renale in relazione ai diversi fattori prognostici (test del chi- quadro) (n = 266)
Fattore prognostico Presente Assente
Ittero 25% 48.9% p<0.0001 Coma 27.9% 56.1% p<0.0001 Sepsi 35.8% 49.1% p=0.033 Oliguria 34.4% 59.5% p<0.0001 Ventilazione meccanica 39.5% 66.7% p=0.028 Inotropi inizio CRRT 40.2% 48.8% ns Inotropi 48h CRRT 39.2% 49.2% ns
46
FIGURE
Fig. 1 CRRT: anticoagulazione in pazienti con AKI grave e MODS post cardio-chirurgica
*Alto rischio emorragico:
Conta PLT < 50 x 103/µL, sanguinamento spontaneo, aPTT allungato (> 45 sec), recente intervento chirurgica (< 48h). Durata Filtro < 24 h Durata Filtro > 24 h Anticoagulazione regionale eparina- protamina o citrato
Selezione pazienti ad alto rischio di sanguinamento*
No anticoagulazione No anticoagulazione
47
Fig. 2: Tipo di intervento chirurgico
Altro 5,7% SV+RM 12,6% SV 21,1% SAA 33,0% RM 27,6% RM = Rivascolarizzazione Miocardica SAA = Sostituzione Aorta Ascendente SV = Sostituzione Valvolare
SV+RM = Sostituzione Valvolare + Rivascolarizzazione Miocardica
Altro = Trapianto cardiaco, Riparazione difetto interventricolare, Aneurisma ventricolare, Dotto di
Botallo pervio, ecc
48 10 20 30 40 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 HCO3-(mEq/L) 3 4 5 6 7 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 K+ (mEq/L) 0 50 100 150 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 BUN (mg/dL)
Durata trattamento: 16.6 ± 15 gg. (mediana 12 gg.)
49
Fig. 4: Sopravvivenza in rapporto al punteggio APACHE II
0 20 40 60 80 100 ≤24 25-29 30-34 ≥35 7--44 30 giorni dimissione % S O P R A V V I V E N Z A A P A C H E II score (1°giorno CRRT ) (n=48) (n=53) (n=85) (n=80) (n=266) 54% 37%
50 0 20 40 60 80 100 87,8% 14,5% 41,4% 59,5% 34,4% Cr 1,4±0,6 mg/dl Cr 2,2±0,9 mg/dl Cr 2,03±1 mg/dl % pazienti con recupero
Prognosi favorevole (n=75) Deceduti (n=151) Totale (n=266) IRA non oligurica (n=58) IRA oligurica (n=168)
51 0 10 20 30 40 50 <8 8--14 15-21 22-28 >28 18,2% (n=20)18,2% (n=20) 10,9% (n=12) 10,9% (n=12) 11,8% (n=13) 11,8% (n=13) 20,9% (n=23) 20,9% (n=23) 38,2% (n=42) 38,2% (n=42) N = 110 N = 110 Tempo di recupero (giorni) % pazienti
52 0 20 40 60 80 100 6--9 10--13 14--17 18--22 Sottogruppi SOFAmax % R E C U P E R O N=110 (n=11) (n=40) (n=44) (n=15)
53 0% 20% 40% 60% 80% 100% <8 8--14 15-21 22-28 >28 non-oliguria oliguria
54
BIBLIOGRAFIA
1. Rosner MH, Okusa MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol 2006; 1: 1932.
2. Conlon PJ, Stafford-Smith M, White WD et al. Acute renal failure following cardiac sur- gery. Nephrol Dial Transplant 1999; 14: 1158-1162.
3. Lange HW, Aappli DM, Brown DC. Survival of patients with acute renal failure requiring dialysis after open heart surgery: Early prognostic indicators. Am.Heart J. 113:1138-1143, 1987.
4. Mehta RL, Pascual MT, SorokoS, et al. Spectrum of acute renal failure in the intensive care unit: The PICARD experience. Kidney Int 2004; 66:1613-21.
5. Liano F, Junco E, Pascual J, Madero R et al. The Spectrum of acute renal failure in the in- tensive care unit compared with that seen in other settings. The Madrid Acute Renal Failure Study Group. Kidney Int 1998; suppl 66:S 16-24.
6. Bellomo R, Ronco C, Kellum JA et al. Acute renal failure: Definition, outcomes measures, animal models, fluid therapy and information technology needs. The Second International Consensus Conference of the Acute Dialysis Qualitive Initiative (ADQI) Group. Crit.Care 2004; 8: R2904-12.
7. Srisawat N, Hoste EEA, Kellum JA. Modern classification of Acute Kidney Injury. Blood Purif 2010; 29: 300-307.
8. Mehta RL, Kellum JA, Shah SV et al. Acute Kidney Injury Network (AKIN): Report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 2:597-600.
55
9. Kellum JA, Bellomo R, Ronco C. The concept of acute kidney injury and the RIFLE crite- ria. Contrib Nephrol. 2007; 156: 10-6.
10. Englberger L, Suri RM, Li Z, Casey ET, Daly RC, Dearani JA. Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for acute kidney injury in patients under- going cardiac surgery. Critical Care 2011; 15:R16.
11. Robert AM, Kramer RS, Dacey LI et al. Cardiac surgery-associated acute kidney injury: a comparison of two consensus criteria. Ann Thorac Surg. 2010; 90(6): 1939-1943.
12. Macedo E, Bouchard J, Soroko SH, Chertow GM, Himmelfarb J, Ikizler TA, Paganini EP, Metha RL for the PICARD study. Fluid accumulation, recognition nand staging of acute kidney injury in crically-ill patients. Critical Care 2010; 14:R82.
13. Morabito S, Guzzo I, Solazzo A, Muzi L, Pistolesi V, Pierucci A. Acute renal failure follo- wing cardiac surgery. G Ital Nefrol. 2006; 23 Suppl 36:S52-60.
14. Rosner MH; Portilla D, Okusa MD. Cardiac surgery as a cause of acute kidney injury: path- ogenesis and potential therapies. J Intensive Care Med. 2008; 23(1): 3-18.
15. Chertow GM, Lazarus JM, Christiansen CL et al. Preoperative renal risk stratification. Circulation 1997; 18: 878-884.
16. Thakar CV, Worley S, Arrigain S, Yared JP, Paganini EP. Influence of renal dysfunction on mortality after cardiac surgery: modifying effect of preoperative renal function. Kidney Int 2005; 67: 1112-1119.
17. Grayson AD, Khater M, Jackson M, Fox MA. Valvular heart operation is an independent risk factor for acu e renal failure. Ann Thorac Surg 2003; 75: 1829-1835.
18. Nigwekar SU, Kardula P, Hix JK, Thakar CV. Off pump coronary artery bypass surgery and acute kidney injury: a meta-analysis of randomized and observational studies. Am J Kidney Dis. 2009 Sep; 54 (3): 413-23.
56
19. Ascione R, Lloyd CT, Underwood MJ, Gomes WJ, Angelini GD. On-pump versus off-pump coronary revascularization: evaluation of renal function. Ann Thorac Surg 1999; 68: 493- 498.
20. Ascione R, Nason G, Al-Ruzzeh S, Ko C, Ciulli F, Angelini GD. Coronary revascularization with or without cardiopulmonary bypass in patients with preoperative non dialysis- dependent renal insufficiency. Ann Thorac Surg 2001; 72: 2020-2025.
21. Boldt J, Brenner T, Lehmann A, Suttner SW, Kumle B, Isgro F. Is kidney function altered by the duration of cardiopulmonary bypass? Ann Thorac Surg 2003; 75: 906-912.
22. Coleman MD, Shaefi S, Sladen RN.
Preventing acute kidney injury after cardiac surgery. Curr Opin Anaesthesiology 2011Feb;24(1):70-6
23. Fischer UM, Weissenberger WK, Warters RD, Geissler HJ, Allen SJ, Mehlhorn U. Impact of cardiopulmonary bypass management on postcardiac surgery renal function. Perfusion.
2002 Nov; 17(6):401-6.
24. De leeuw PW, Van Der Starre PJ, Harinck-de Weerdt JE et al. Humoral changes during and following coronary bypass surgery: relationship to postoperative blood pressure. J Hyper- tens Suppl. 1983 Dec; 1(2):52-4.
25. Mishra J, Tarabishi R, Mitsnefes MM et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 2005; 365: 1231- 1238.
26. Haase M, Bellomo R, Devarajan P, Ma Q, Bennet MR, Mockel M, Matalanis G, Dragun D, Haase-Fielitz A. Novel biomarkers early predict the severity of acute kidney injury after cardiac surgery in adults. Ann. Thorac. Surg. 2009; 88(1): 124-30.
27. Bennett M, Dent CL, Ma Q, Dastrala S, Grenier F, Workman R, Syed H, Ali S, Barasch J, Devarajan P. Urine NGAL predicts severity of acute kidney injury after cardiac surgery: a prospective study. Clin J Am Soc Nephrol 2008; 3: 665-673.
57
28. Perry TE, Muehischlegel JD, Liu KY, Fox AA, Collard CD, Shernan SK, Body SC. Plasma neutrophil gelatinase-associated lipocalin and acute postoperative kidney injury in adult cardiac surgical patients. Anesth Analg 2010 1; 110(6): 1541-1547.
29. Koyner JL, Vaidya VS, Bennett MR, Ma Q, Worcester E, Akhter SA, Raman J, Jeevanandam V, O’Connor MF, Devarajan P, Bonventre JV, Murray PT. Urinary biomarkers in the clinical prognosis and early detection nof acute kidney injury. Clin J Am Soc Nephrol 2010; 5: 2154-2165.
30. Devarajan P. Neutrophil gelatinase-associated lipocalin: a promising biomarker for human acute kidney injury. Biomark Med 2010; 4(2): 265-280.
31. Koyner JL, Bennett MR, Worcester EM, Ma Q, Raman J, Jeevanandam V, Kasza KE, O’Connor MF, Konczal DJ, Trevino S, Devarajan P, Murray T. Urinary cystatin C as an early biomarker of acute kidney injury following adult cardiothoracic surgery. Kidney Int 2008; 74 (8): 1059-1069.
32. Liangos O, Tihiouart H, Perianayagam MC, Kolyada A, Han WK, Bonventre JV, Jaber BL. Comparative analysis of urinary biomarkers for early detection of acute kidney injury following cardiopulmonary bypass. Biomarkers 2009; 14(6): 423-431.
33. Fang WC, Helm RE, Krieger KH et al. Impact of minimum hematocrit during cardiopulmo- nary bypass on mortality in patients undergoing coronary artery surgery. Circulation 1997; 96 (9 suppl): II-194-199.
34. Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah A. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? J Thorac Cardiovasc Surg 2003; 125: 1438-1450.
35. Habib RH, Zacharias A, Schwann TA, Riordan CJ, Engoren M, Durham SJ, Shah A. Role of hemodilutional anemia and trasfusion during cardiopulmonary bypass in renal injury after coronary revascularization: implications on operative outcome. Crit. Care Med. 2005; 33(8):1749-56.
58
36. Mason J, Welsch J, Torhorst J. The contribution of vascular obstruction to the functional de- fect that follows renal ischemia. Kidney Int 1987; 31: 65-71.
37. Hellberg PO, Bayati A, Kallskog O, Wolgast M. Red cell trapping after ischemia and long- term kidney damage. Influence of hematocrit. Kidney Int. 1990; 37: 1240-1247.
38. Karkouti K, Beattie WS, Wijeysundera DN et al. Hemodilution during cardiopulmonary by- pass is an independent risk factor for acute renal failure in adult cardiac surgery. J Thorac Cardiovasc Surg 2005; 129: 391-400.
39. Koyner JL, Murray PT. Mechanical Ventilation and the Kidney. Blood Purif 2010; 29:52- 68.
40. Fortescue EB, Bates DW, Chertow G. Predicting acute renal failure after coronary bypass surgery: Cross-validation of two risk-stratification algorithms. Kidney International 2000; 57: 2594-2602.
41. Eriksen BO, Hoff KRS, Solberg S. Prediction of acute renal failure after cardiac surgery: retrospective cross-validation of a clinical algorithm. Nephrol Dial Transplant 2003; 18: 77- 81.
42. Thakar CV, Arrigain S, Worley S, Yared JP, Paganini EP. A clinical score to predict acute renal failure after cardiac surgery. J Am Soc Nephrol 2005; 16: 162-168.
43. Candela-Toha A, Eli as-Martí E, Abraira V, Tenorio MT, Parise D, de Pablo A, Centella T, Liano F. Predicting acute renal failure after cardiac surgery: external validation of two new clinical scores. Clin J Am Soc Nephrol 2008; 3:1260-1265.
44. Engelberger L, Suri RM, Li Z, Dearani JA, Park SJ, Sundt TM 3rd; Schaff HV. Validation of
clinical scores predicting severe acyte kidney injury after cardiac surgery. Am J Kidney Dis. 2010; 56(4): 623-631.
45. Wijeysundera DN, Karkouti K, Dupuis JY, Rao V, Chan CT, Granton JT, Beattie WS, Predictive index for renal replacement therapy after cardiac surgery. JAMA 2007; 297(16): 1801-1809.
59
46. Ko B, Garcia S, Mithani S, Tholakanahalli V, Adabag S.
Risk of acute kidney injury in patients who undergo coronary angiography and cardiac surgery in close succession.
Eur Hearth J.2012 Aug.33(16):2065-2070
47. Morabito S, Simonetti BM, Guzzo I et al. Continuous renal replacement therapies in acute renal failure following cardiac surgery: prognostic factors. J Nephrol 2001; 14: 542.
48. Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med 1998; 104: 343-348.
49. Barrantes F, Tian J, Vazquez R, Amoateng-Adjepong Y, Manthous CA. Acute kidney injury criteria predict outcomes of critically ill patients. Crit Care Med. 2008; 36(5):1397- 403.
50. Thakar CV, Christianson A, Freyberg R, Almenoff P, Render ML. Incidence and outcomes of acute kidney injury in intensive care units: A Veterans Administation study. Crit Care Med. 2009 (Epub ahead of print).
51. Lassnigg A, Schmidlin D, Mouhieddine M et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol 2004; 15: 1597-1605.
52. Ishani A, Nelson D, Clothier B, Schult T, Nugent S, Greer N, Slinin Y, Ensrud KE. The magnitude of acute serum creatinine increase after cardiac surgery and the risk of chronic kidney disease, progression of kidney disease and death. Arch Intern Med 2011; 171(3): 226-233.
53. Loef BG, Epema AH, Smilde TD et al. Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival. J Am Soc Nephrol 2005; 16: 195-200.
60
54. Hobson CE, Yavas S, Segal MS, Schold JD, Tribble CG, Layon AJ, Bihorac A. Acute kidney injury is associated with long-term mortality after cardiothoracic surgery. Circulation, 2009, 12;119(18): 2444-53.
55. Thakar CV, Yared JP, Worley S, Cotman K, Paganini EP. Renal dysfunction and serious in- fections after open-heart surgery. Kidney Int 2003; 64: 239-246.
56. Reynvoet E, Vandijck DM, Blot SI, Dhondt AW, De Waele JJ, Claus S, Buyle FM, Vanholder RC, Hoste EA. Epidemiology of infection in critically ill patients with acute renal failure. Crit Care Med. 2009; 37(7):2203-9.
57. Morabito S, Pierucci A, Palumbo R, Cicciarelli A, Guzzo I, Cinotti GA, Chiavarelli R, Cassese M: Early predictive indicators of mortality in patients with acute renal failure associated with multiple organ failure. [Abstract]. J Am Soc Nephrol 1997; 8:204°
58. Baudouin SV, Wiggins J, Keogh BF, Morgan CJ, Evans TW. Continuous veno-venous haemofiltration following cardio-pulmonary bypass. Indications and outcome in 35 patients. Intensive Care Med 1993; 19: 290-293.
59. Leacche M, Rawn JD, Mihaljevic T et al. Outcomes in patients with normal serum creati- nine and with artificial renal support for acute renal failure developing after coronary artery bypass grafting. Am J Cardiol 2004; 93: 353–356.
60. Lugones F, Chiotti G, Carrier M et al. Continuous renal replacement therapy after cardiac surgery. Review of 85 cases. Blood Purif 2004; 22: 249-255.
61. Tsang GM, Khan I, Dar M, Clayton D, Waller D, Patel RL. Hemofiltration in a cardiac in- tensive care unit: time for a rational approach. ASAIO J 1996; 42: 710-713.
62. Lawman SH, Cohen SL, Batson SD. Acute renal failure after cardiothoracic surgery: a re- view of three years experience. Blood Purif 2002; 20: 293-295.
63. Bellomo R, Boyce N. Acute continuous hemodiafiltration: a prospective study of 110 patients and a review of the literature. Am J Kidney Dis 1993; 21:508-518.
61
64. Kellum JA, Angus DC, Johnson JP et al. Continuous versus intermittent renal replacement therapy: a meta-analysis. Intensive Care Med 2002; 28: 29-37.
65. Kellum JA, Mehta RL, Angus DC, Palevsky P, and Ronco C, for the ADQI Workgroup. The first international consensus conference on continuous renal replacement therapy. Kidney Int 2002; 62: 1855-1863.
66. Morabito S, Guzzo I, Solazzo A, Muzi L, Luciani R, Pierucci A. Continuous renal replace- ment therapies: anticoagulation in the critically ill at high risk of bleeding. J Nephrol 2003; 16: 566-571.
67. Mariano F., Triolo G. L’anticoagulazione del circuito extracorporeo nei pazienti critici in te- rapia intensiva. Giornale Italiano di Nefrologia 2007; 24 (1): 34-42
68. Tonelli M, Manns B, Feller-Kopman D. Acute renal failure in the intensive care unit: a sys- tematic review of the impact of dialytic modality on mortality and renal recovery. Am J Kidney Dis 2002; 40: 875-885.
69. Rabindranath K, Adams J, Macleod AM, Muirhead N. Intermittent versus continuous renal replacement therapy for acute renal failure in adults. Cochrane Database Syst Rev. 2007; 18 (3): CD003773.
70. Kellum JA, Metha RL, Angus DC, Palevsky P, Ronco C, ADQI Workgroup. The first inter- national consensus conference on continuous renal replacement therapy. Kidney Int. 2002; 62(5): 1855-1863.
71. Ceriani R, Mazzoni M, Bortone F et al. Application of the Sequential Organ Failure As- sessment score to cardiac surgical patients. Chest 2003; 123: 1229-1239.
72. Paganini EP, Tapolyai M, Goormastic M et al. Establishing a dialysis therapy/patient out- come link in intensive care unit acute dialysis for patients with acute renal failure. Am J Kidney Dis 1996; 28(5) suppl 3: S81-S89.
62
73. Ronco C, Bellomo R, Homel P et al. Effects of different doses in continuous veno-venous hemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet 2000; 356: 26-30.
74. Bent P, Tan HK, Bellomo R et al. Early and intensive continuous hemofiltration for severe renal failure after cardiac surgery. Ann Thorac Surg 2001; 71: 832-837.
75. Liano F, Gallego A, Pascual J et al. Prognosis of acute tubular necrosis: an extended pro- spectively contrasted study. Nephron 1993; 63: 21-31.
76. Elahi MM, Lim MY, Joseph RN, Dhannapuneni RR, Spyt TJ. Early hemofiltration improves survival in post-cardiotomy patients with acute renal failure. Eur J Cardiothorac Surg 2004; 26: 1027-1031.
77. García-Fernández N, Pérez-Valdivieso JR, Bes-Rostrollo M, Vives M, Lavilla J, Herreros J, Monedero P. Timing of renal replacement therapy after cardiac surgery: a retrospective mul- ticenter spanish cohort study. Blood Purif. 2011 2; 32(2): 104-111.
78. Dermikilic U, Kuralay E, Yenicesu M et al. Timing of replacement therapy for acute renal failure after cardiac surgery. J Card Surg 2004; 19: 17-20.
79. Macedo E, Mehta RL. Early vs late start of dialysis: it’s all about timing. Critical Care 2010; 14: 112.
80. Schiffl H. Renal recovery after severe acute renal injury. Eur J Med Res. 2008; 3; 13(12):552-6.
81. Metha RH, Honeycutt E, Patel UD, Lopes RD, Shaw LK, Glower DD, Harrington RA, Califf RM, Sketch MH Jr. Impact of recovery of renal function on long-term mortality after coronary artery bypass grafting. Am J Cardiol 2010; 106(12): 1728-1734.
82. Swaminathan M, Hudson CC, Philips-Bute BG, Patel UD, Newman MF, Milano CA, Shaw AD, Stafford-Smith M. Impact of early recovery on survival after cardiac surgery-associated acute kidney injury. Ann Thorac Surg 2010; 89(4): 1098-1104.
63
83. Helmut Schiffl : Renal recovery from acute tubular necrosis requiring renal replacement therapy: a prospective study in critically ill patients. Nephrol Dial Trasplant 2006.
84. Bagshaw SM, Mortis G, Godinez-Luna T, Doig CJ, Laupland KB. Renal recovery after se- vere acute renal failure. Int J Artif Organs 2006; 29(11): 1023-1030.
85. Schmitt R, Coca S, Kanbay M, Tinetti ME, Cantley LG, Parikh CR. Recovery of kidney function after acute kidney injury in the elderly: a systematic review and meta-analysis. Am J Kidney Dis 2008; 52(2): 262-271.
86. Bouman CS, Oudemans-Van Straaten HM, Tissen JG, Zandstra DF, Kesecioglu J. Effects of early high-volume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: a prospective, randomized trial. Crit Care Med 2002; 30(10): 2205-2211.
87. Ponikvar JB, Rus RR, Kenda RB, Bren AF, Ponikvar RR. Low-flux versus high-flux syn- thetic dialysis memebrane in acute renal failure: prospective randomized study. Artif Organs 2001; 25(12): 946-950.
88. Mehta RL, McDonald B, Gabbai FB, Pahl M, Pascual MTA, Farkas A, Kaplan R for the collaborative group for treatment of ARF in the ICU. A randomized clinical trial of continu- ous versus intermittent dialysis for acute renal failure. Kidney International 2001; 60: 1154- 1163.
89. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative thera- pies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644-55.
90. Shigehiko Uchino, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C. Acute renal failure in critical- ly ill patients. JAMA 2005; 294(7): 813-818.
64
91. Luckraz H, Gravenor MB, George R et al. Long and short-term outcomes in patients requir- ing continuous renal replacement therapy post cardiopulmonary bypass. Eur J Cardiothorac Surg 2005; 27: 906-909
92. Park M, Coca SG, Nigwekar SU, Garg AX, Grawood S, Parikh CR. Prevention and treat- ment of acute kidney injury in patients undergoing cardiac surgery: a systematic review. Am J Nephrol 2010; 31: 408-418.
93. Kallel S, Triki Z, Abdenadher M, Frikha I, Jemel A, Karoui A.
Acute renal failure after cardiac surgery: Evaluation of the RIFLE criteria. Nephrol Ther.2012 Aug 21