Bell Max, Granath Fredrik, Schön Staffan, Ekbom Anders, Martling Claes-Roland
Department of Anaesthesiology and Intensive Care, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden.
Department of Medicine, Clinical Epidemiology Unit, Karolinska University Hospital, Solna, Sweden.
Intensive Care Med. 2007 May;33(5):773-780. doi: 10.1007/s00134-007-0590-6. Epub 2007 Mar 16.
Acute renal failure can be treated with continuous renal replacement therapy (CRRT) or intermittent haemodialysis (IHD). Whether this choice affects renal recovery has been debated, since it has implications on quality of life and costs. Our objective was to determine the impact of CRRT and IHD on renal recovery.
Nationwide retrospective cohort study between the years 1995 and 2004. Follow-up ranged between 3 months and 10 years.
Thirty-two Swedish intensive care units.
Eligible subjects were adults treated in Swedish general intensive care units with RRT. A total of 2,642 patients from 32 ICUs were included. We then excluded patients with end-stage renal disease (252) and patients lacking a diagnosis in the in-patient register (188). Thus, 2,202 patients were studied. Follow-up was complete.
None.
The primary outcome was renal recovery. Secondarily we studied the mortality of the cohort. There were no differences between IHD and CRRT patients regarding baseline characteristics, such as age, sex and comorbidities. Of the 1,102 patients surviving 90 days after inclusion in the cohort, 944 (85.7%) were treated with CRRT and 158 (14.3%) were treated with IHD. Seventy-eight patients (8.3%; confidence interval, CI, 6.6-10.2), never recovered their renal function in the CRRT group. The proportion was significantly higher among IHD patients, where 26 subjects or 16.5% (CI 11.0-23.2) developed need for chronic dialysis.
The use of CRRT is associated with better renal recovery than IHD, but mortality does not differ between the groups.
急性肾衰竭可采用连续性肾脏替代治疗（CRRT）或间歇性血液透析（IHD）进行治疗。由于这一选择对生活质量和成本有影响，因此其是否会影响肾脏恢复一直存在争议。我们的目的是确定CRRT和IHD对肾脏恢复的影响。
1995年至2004年的全国性回顾性队列研究。随访时间为3个月至10年。
瑞典的32个重症监护病房。
符合条件的受试者为在瑞典普通重症监护病房接受肾脏替代治疗的成年人。共纳入了来自32个重症监护病房的2642例患者。然后我们排除了终末期肾病患者（252例）和住院登记中缺乏诊断信息的患者（188例）。因此，对2202例患者进行了研究。随访完整。
无。
主要结局是肾脏恢复。其次，我们研究了该队列的死亡率。IHD组和CRRT组患者在年龄、性别和合并症等基线特征方面没有差异。在队列中纳入后存活90天的1102例患者中，944例（85.7%）接受了CRRT治疗，158例（14.3%）接受了IHD治疗。CRRT组中有78例患者（8.3%；置信区间，CI，6.6 - 10.2）肾功能从未恢复。IHD患者中的这一比例显著更高，有26例患者即16.5%（CI 11.0 - 23.2）需要进行慢性透析。
与IHD相比，CRRT的使用与更好的肾脏恢复相关，但两组之间的死亡率没有差异。
