Discussion
toxicity, ischemia, hyperkalemia, AKI, acidemia, septic
FLUID OVERLOAD, CIRCULATORY FAILURE, ISCHEMIA, ACIDEMIA, COMPLICATIONS
The application of RRT is mainly to treat AKI patients with refractory complications, such as hyperkalemia, acidemia, fluid overload, and toxicity. However, the frequencies of these urgent indications for RRT in critically care setting are less commonly occurred and could be avoided in most of time [In this study, we presented a precise nomogram based on abundant clinical information from the MIMIC-III database to predict the probability of RRT among AKI patients in ICU. Most of our data were measured at AKI detection, which allows timely intervention as compared with other large prospective studies that predicted adverse outcomes in patients already receiving RRT at baseline [Serum creatinine and blood urea nitrogen at AKI detection were still the leading causes to influence the decision of RRT. However, only relying on sCr, BUN or AKI stage did not meet the decision criteria of starting RRT according to the predictive nomogram. In one multicenter randomized trial, Gaudry et al. enrolled 630 patients who were admitted to the ICU with KDIGO Stage 3 AKI [As regard to hemoglobin concentration, it is an important component of arterial oxygen content, which plays a major role in oxygen delivery. Therefore, low hemoglobin concentration can exacerbate oxygen delivery to the kidney and result in tissue ischemia in the renal medulla [Serum lactate is also a well-known biomarker to reflect the severity of circulatory failure and AKI. It has also been shown to the need for RRT in septic patients [Several limitations should be addressed when interpreting the results of this study. First, we only included patients in a public database from a single center, which may limit generalizability of the results. Therefore, the model needs to be verified by multiple medical centers. Second, we used data from MIMIC-III database, raising the possibility of selection bias. Third, the etiology of AKI was also an important factor to determine whether to initiate RRT. However, due to the nature of retrospective study, it was difficult to find out the definite reason of AKI, which prevented us from discussing this aspect. Finally, our nomogram was limited by the retrospective nature of data collection and failed to evaluate the survival benefit of RRT initiation based on nomogram strategy. Further efforts on prospective data collection and clinical application are encouraged to verify the model.