Andrade Lúcia, Cleto Sérgio, Seguro Antonio C
Intensive Care Unit, Emílio Ribas Institute of Infectology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
Clin J Am Soc Nephrol. 2007 Jul;2(4):739-44. doi: 10.2215/CJN.00680207. Epub 2007 Jun 20.
Leptospirosis is a public health problem, the severe form of which (Weil's disease) includes acute respiratory distress syndrome, typically accompanied by acute kidney injury (AKI), and is associated with high mortality rates. Recent evidence suggests that dialysis dosage affects outcomes in critically ill patients with sepsis-induced AKI. However, this population varies widely in terms of age, gender, and concomitant conditions, making it difficult to determine the appropriate timing (door-to-dialysis time) and dialysis dosage.
DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: It is logical to assume that increasing the dialysis dosage would minimize uremic complications and improve outcomes in such patients. Patients with Weil's disease constitute a homogeneous population and are typically free of comorbidities, therefore presenting an ideal model in which to test this assumption.
The effects of dialysis dosage were evaluated in this population, with the use of either classic or slow low-efficiency hemodialysis, and two periods/treatment plans were compared: 2002 to 2003/delayed, alternate-day dialysis (DAdD group; n = 15) and 2004 to 2005/prompt and daily dialysis (PaDD group; n = 18). Age, gender, AKI severity, APACHE score, serum urea, and time to recovery of renal function were assessed. All patients received vasoactive drugs (because of hemodynamic instability) and were on mechanical ventilation (because of acute respiratory distress syndrome). Mean serum urea during the dialysis period was significantly lower in the PaDD group than in the DAdD group. Of the PaDD group patients, three (16.7%) died, compared with 10 (66.7%) of the DAdD group patients.
On the basis of this result, it is believed that alternate-day hemodialysis is no longer appropriate for critically ill patients with Weil's disease.
钩端螺旋体病是一个公共卫生问题，其严重形式（韦尔氏病）包括急性呼吸窘迫综合征，通常伴有急性肾损伤（AKI），且死亡率很高。最近的证据表明，透析剂量会影响脓毒症诱导的急性肾损伤重症患者的预后。然而，这一人群在年龄、性别和伴随疾病方面差异很大，因此很难确定合适的时机（从入院到开始透析的时间）和透析剂量。
设计、设置、参与者和测量：可以合理推测，增加透析剂量会使此类患者的尿毒症并发症降至最低，并改善预后。韦尔氏病患者构成了一个同质化群体，通常没有合并症，因此是检验这一推测的理想模型。
在这一群体中评估了透析剂量的影响，采用经典或缓慢低效血液透析，并比较了两个时期/治疗方案：2002年至2003年/延迟隔日透析（DAdD组；n = 15）和2004年至2005年/及时每日透析（PaDD组；n = 18）。评估了年龄、性别、急性肾损伤严重程度、急性生理与慢性健康状况评分系统（APACHE）评分、血清尿素以及肾功能恢复时间。所有患者均接受血管活性药物治疗（由于血流动力学不稳定）并接受机械通气（由于急性呼吸窘迫综合征）。透析期间，PaDD组患者的平均血清尿素显著低于DAdD组。PaDD组中有3名患者（16.7%）死亡，而DAdD组为10名患者（66.7%）。
基于这一结果，认为隔日血液透析不再适用于韦尔氏病重症患者。
