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

BACKGROUND

Kidney Replacement Therapy (KRT) timing in septic shock remains debated. We assessed temporal trends in KRT initiation and outcomes in Japan.

METHODS

Using a nationwide EMR database (2016-2023), we included adults (≥ 20 years) with septic shock admitted to the intensive care unit (ICU) or high-dependency care unit (HDU) on day 0 who received KRT. Outcomes were KRT timing by hospital day, in-hospital mortality, and KRT dependency at discharge; sensitivity analyses used consistently reporting hospitals.

RESULTS

Among 688 hospitalizations (median age 74 years), KRT initiation shifted later, with day ≥ 2 initiation reaching 38.5% in 2023. In 2022, mortality was 54.3% (n = 25), and KRT dependency was 43.5% (n = 20). Patterns were similar across modalities/settings.

CONCLUSIONS

KRT initiation shifted toward later timing after 2022. Studies with granular severity and indication data are needed to clarify drivers of variation and outcomes.