Early Versus Late Renal Replacement Therapy in Preeclamptic Patient Complicated with Acute Kidney Injury

Abstract

Introduction:Preeclampsia remains a major cause of maternal and fetal morbidity and mortality in Egypt and the world. Approximately 1 in 20 pregnancies is complicated by this-disorderPregnancy-related Acute Renal Failure (ARF) may comprise up to 25% of the referrals to dialysis centers in developing countries and is associated with substantial maternal and fetal mortality. AKI is a serious complication of critical illness that is associated with substantial morbidity and mortality. Extracorporeal renal replacement therapy (RRT) has long been used as supportive treatment of AKI, and has traditionally focused on averting the life threatening derangements associated with kidney failure while allowing time for organ recovery. Unfortunately, in the absence of refractory acidemia, toxic hyperkalemia and intravascular fluid over-load contributing to respiratory failure; there is limited evidence to guide clinicians on when to initiate RRT in critically ill patients with AKI. The primary indication for RRT is acute or chronic renal failure. The optimal timing of dialysis for AKI is not defined. In current practice, the decision to start RRT is based most often on clinical features of volume overload and biochemical features of solute imbalance. Patients and methods: Preeclamptic patients (blood pressure ≥140/90 mmHg and proteinurea >300 mg/24 hours), with gestational age from 20 weeks till 2 weeks postpartum, their age range from 18- 34 year, suffering from increase in serum creatinine ≥1.2 mg/dl (as regard hospital normal range) were enrolled in the study. Early intervention group, (Group E) 25 patients; in which preeclamptic patients started dialysis, once serum creatinine doubled with in 24 hours. -Late conventional group, (Group L) 25 patients; in which preeclamptic patients delayed dialysis, continued conventional medical renal protection and started dialysis, once serum creatinine reached 6mg/dl, urea 100mg/dl, Ph ≤7.1, or volume overload. Results:Our study demonstrated that early RRT showed better results regarding less number of dialysis sessions,higher incidenceof maternal indeprndence of dialysis ,increased fetal birth weight compared to late (conventional) dialysis. Conclusion: This study concluded that early RRT in preeclamptic patients suffering AKI reduced ICU stay and showed higher incidence of renal recovery.It is recommended to encourage early renal dialysis just after doubling of serum creatinine acutely within 24 hours. References: Bagshaw,S.M., Uchino,S., Bellomo,R.,et al.(2009): Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury. J Crit Care, 24 :129-140. Can,M.R. (2008):Hemodialysis central venous catheter dysfunction. Sem Dial,21, 516-521.Ejaz,A.A., Mu,W., Kang,D.H., et al.(2007): Could uric acid have a role in acute renal failure? Clin J Am SocNephrol ; 2: 16–21.