Timing of Kidney Replacement Therapy Initiation in Patients With Septic Shock: A Descriptive Study Using a Japanese...

Area of Science:

• Critical Care Medicine
• Nephrology
• Health Services Research

Background:

• The optimal timing for initiating Kidney Replacement Therapy (KRT) in patients experiencing septic shock is a subject of ongoing clinical debate.
• Temporal trends in KRT initiation and associated outcomes in Japan have not been extensively studied.

Purpose of the Study:

• To analyze temporal trends in KRT initiation timing among adult patients with septic shock in Japan.
• To evaluate in-hospital mortality and KRT dependency at discharge in relation to KRT timing.

Main Methods:

• Utilized a nationwide Electronic Medical Record (EMR) database spanning from 2016 to 2023.
• Included adult patients (≥20 years) admitted to ICU or HDU on day 0 with septic shock requiring KRT.
• Assessed KRT initiation timing, in-hospital mortality, and KRT dependency at discharge, with sensitivity analyses on consistently reporting hospitals.

Main Results:

• A total of 688 hospitalizations were analyzed (median age 74 years).
• KRT initiation demonstrated a trend towards later timing, with 38.5% of initiations occurring on day 2 or later by 2023.
• In 2022, in-hospital mortality was 54.3% and KRT dependency at discharge was 43.5%.

Conclusions:

• KRT initiation timing in septic shock patients in Japan has shifted towards later initiation after 2022.
• Further investigation incorporating granular data on patient severity and KRT indications is required to elucidate the drivers of these trends and their impact on outcomes.