Wald Ron, Deshpande Rushi, Bell Chaim M, Bargman Joanne M
Department of Medicine, University of Toronto, Toronto, ON, Canada.
Hemodial Int. 2006 Jan;10(1):82-7. doi: 10.1111/j.1542-4758.2006.01179.x.
Continuous renal replacement therapy (CRRT) is widely used in critically ill patients with acute renal failure (ARF). The survival of patients who require CRRT and the factors predicting their outcomes are not well defined. We sought to identify clinical features to predict survival in patients treated with CRRT. We reviewed the charts of all patients who received CRRT at the Toronto General Hospital during the year 2002. Our cohort (n=85) represented 97% of patients treated with this modality in 3 critical care units. We identified demographic variables, underlying diagnoses, transplantation status, location (medical-surgical, coronary, or cardiovascular surgery intensive care units), CRRT duration, baseline estimated glomerular filtration rate (eGFR), and presence of oliguria (<400 mL/day) on the day of CRRT initiation. The principal outcome was survival to hospital discharge. Among those alive at discharge, we assessed whether there was an ongoing need for renal replacement therapy. Greater than one-third (38%, 32/85) of patients survived to hospital discharge. Three (9%) survivors remained dialysis-dependent at the time of discharge. Survivors were younger than nonsurvivors (mean age 56 vs. 60 years), were on CRRT for a shorter duration (7 vs. 13 days), and had a higher baseline eGFR (74 vs. 62 mL/min/m(2)). Patient survival varied among different critical care units (medical surgical 33%, coronary 38%, and cardiovascular surgery 45%). Multivariable logistic regression revealed that shorter duration of CRRT, nonoliguria, and baseline eGFR >60 mL/min/m(2) were independently associated with survival to hospital discharge (p<0.05). Critically ill patients with ARF who require CRRT continue to have high in-hospital mortality. A shorter period of CRRT dependence, nonoliguria and higher baseline renal function may predict a more favorable prognosis. The majority of CRRT patients who survive their critical illness are independent of dialysis at the time of hospital discharge.
连续性肾脏替代治疗（CRRT）广泛应用于急性肾衰竭（ARF）的重症患者。需要CRRT治疗的患者的生存率以及预测其预后的因素尚未明确。我们试图确定预测接受CRRT治疗患者生存率的临床特征。我们回顾了2002年在多伦多综合医院接受CRRT治疗的所有患者的病历。我们的队列（n = 85）代表了3个重症监护病房接受这种治疗方式患者的97%。我们确定了人口统计学变量、基础诊断、移植状态、治疗地点（内科-外科、冠心病或心血管外科重症监护病房）、CRRT持续时间、基线估计肾小球滤过率（eGFR）以及CRRT开始当天少尿（<400 mL/天）的情况。主要结局是存活至出院。在出院时存活的患者中，我们评估了是否仍需要肾脏替代治疗。超过三分之一（38%，32/85）的患者存活至出院。3名（9%）幸存者出院时仍依赖透析。存活者比非存活者年轻（平均年龄56岁对60岁），接受CRRT的时间更短（7天对13天），且基线eGFR更高（74对62 mL/min/m²）。不同重症监护病房的患者生存率有所不同（内科-外科33%，冠心病科38%，心血管外科45%）。多变量逻辑回归显示，CRRT持续时间较短、非少尿以及基线eGFR>60 mL/min/m²与存活至出院独立相关（p<0.05）。需要CRRT治疗的ARF重症患者院内死亡率仍然很高。CRRT依赖时间较短、非少尿和较高的基线肾功能可能预示预后更良好。大多数在重症疾病中存活的CRRT患者出院时无需透析。
