Abstract: 【Abstract】Objective To determine whether early initiation of renal replacement therapy (RRT) can reduce all-cause mortality within 90 days in sepsis patients complicated with acute kidney injury (AKI). Methods Sixty-nine sepsis patients with AKI stage 3 were enrolled in this study and randomly assigned into early group (n=35) in which RRT was initiated immediately after randomization, or delayed group in which RRT was initiated when emergent indications appeared. Continuous hemofiltration combined with hemoperfusion was the RRT mode. The primary end point was all-cause mortality within 90 days after randomization. The secondary end points included mechanical ventilation period, staying in ICU period and hospitalization day. Results All-cause mortality within 90 days did not differ significantly between early group (42.9%) and delayed group (50%) (χ²=0.354, P=0.552). Mechanical ventilation time was similar between early group and delayed group (286±147h vs. 334±172 h; t=-1.125, P=0.265). The period staying in ICU was similar between the two groups [12 (10, 16) days in early group vs. 16 (12, 22) days in delayed group; Z=-1.555, P=0.120], but hospitalization day was significantly shorter in early group than in delayed group [20 (18, 24) days vs. 26 (19, 30) days; Z=-2.440, P=0.015]. Conclusions For sepsis patients complicated with AKI stage 3, there was no significant difference in mortality between early and delayed initiation of RRT. However, early RRT can reduce the average hospitalization day.

Key words: Sepsis, Acute kidney injury, Renal replacement therapy, Mortality