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J Korean Soc Emerg Med > Volume 32(3); 2021 > Article
Journal of The Korean Society of Emergency Medicine 2021;32(3): 242-248.
급성 신손상 환자에서 나트륨 분획 배설의 측정 시기와 중장기 임상적 예후 간의 관계
김태효 , 최현수 , 박성수 , 이재광 , 류현식 , 민동규
건양대학교병원 응급의학과
Association between measurement time of fractional excretion rate of sodium and mid-long term clinical prognosis in acute kidney injury patients
Tae Hyo Kim , Hyun Soo Choi , Sung Soo Park , Jae Gwang Lee , Hyun Sik Ryu , Dong Kyu Min
Department of Emergency Medicine, Konyang University Hospital, Daejeon, Korea
Correspondence  Hyun Soo Choi ,Tel: 042-600-9119, Fax: 042-600-9028, Email: hschoi@kyuh.ac.kr,
Received: August 4, 2020; Revised: October 14, 2020   Accepted: November 5, 2020.  Published online: June 30, 2021.
ABSTRACT
Objective:
Rapid identification of the cause for acute kidney injury (AKI) is very crucial. Among the diagnostic indicators of AKI, the fractional excretion rate of sodium (FENa) is clinically considered the most useful indicator. Numerous studies have reported that rapid identification and treatment of AKI improves the short-term clinical prognosis of AKI patients. However, insufficient studies have reported on the benefits of early assessment of FENa to help improve the mid-long term clinical prognosis of AKI patients.
Method:
We analyzed the timing of FENa in AKI patients who were admitted through our hospital emergency department, over a period of 3 years. The experimental groups are divided into the early group, measuring FENa within 3 hours after arrival in the emergency room, and the late group, measuring FENa later than 3 hours after arrival in the emergency room. The prognostic outcomes determined are major adverse kidney events (MAKE), including new dialysis, deterioration of kidney function to chronic kidney disease (CKD), and death, as well as MAKE and AKI recurrence (MAKER).
Results:
Significant differences were obtained between the early group and late group in time taken to start fluid resuscitation (P=0.001), intermittent hemodialysis (P=0.005), and continuous renal replacement therapy (P=0.016), as well as in the mid-long term clinical prognosis of new dialysis (P=0.018) and deterioration of kidney function to CKD (P=0.004). Differences between early group and late group in MAKE (P<0.001) and MAKER (P<0.001) were also statistically significant. In the mid-long term clinical prognosis of death (P=0.706) and AKI recurrence (P=0.466), no significant differences were obtained between the two groups.
Conclusion:
Early measurement of FENa (within 3 hours) for AKI patients visiting the emergency room showed better mid-long term clinical prognosis than patients with delayed FENa measurement.
Key words: Acute kidney injury; FENa; Mid-long term prognosis
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