Early initiation of continuous renal replacement therapy improves outcome in sepsis-associated acute kidney injury

To investigate the effect of initiation timing of Continuous Renal Replacement Therapy (CRRT) on prognosis in Sepsis-Associated Acute Kidney Injury (SAKI).

A total of 113 SAKI patients receiving CRRT were stratified by initiation timing: early-stage (ES, ≤ 12 h; n = 51), intermediate-stage (IS, 12-24 h; n = 35), and advanced-stage (AS, > 24 h; n = 27). Organ function (SOFA score), inflammatory markers (C-reactive protein, CRP; procalcitonin, PCT), renal function (serum creatinine, SCr), clinical course (ICU stay, mechanical ventilation, CRRT duration), and 90-day survival were compared.

The AS Group showed the most severe multi-organ dysfunction at day 3, with higher SOFA scores (12 vs. 8 in ES, P = 0.037), BNP (809 vs. 361 pg/mL, P < 0.001), and INR (2.21 vs. 1.53, P < 0.001). Inflammation markers were also highest in AS (CRP: 92.81 mg/L; PCT: 4.25 ng/mL; P = 0.009 and P = 0.002). By day 5, SCr was significantly higher in AS (165.77 μmol/L) than ES (127.17 μmol/L, P = 0.004). The AS Group had longer ICU stays (12.5 d vs. 9.5 d, P = 0.031) and mechanical ventilation (8.5 vs. 5.5 d, P = 0.046), but shorter CRRT duration (130.5 vs. 145.6 h, P = 0.035). Although 90-day mortality did not differ statistically (ES 45.1% vs. AS 63.0%; P = 0.767), survival analysis showed AS had a 4.83-fold higher mortality risk than ES (HR = 4.83, P < 0.001).

Early CRRT (≤ 12 h) improved organ function, enhanced inflammatory control, and reduced mortality risk, while delayed initiation (> 24 h) correlated with worse outcome.