Wu Vin-Cent, Ko Wen-Je, Chang Hong-Wei, Chen Yung-Wei, Lin Yu-Feng, Shiao Chih-Chung, Chen Yung-Ming, Chen Yih-Sharng, Tsai Pi-Ru, Hu Fu-Chang, Wang Jann-Yuan, Lin Yen-Hung, Wu Kwan-Dun
Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan.
Intensive Care Med. 2008 Jan;34(1):101-8. doi: 10.1007/s00134-007-0813-x. Epub 2007 Aug 15.
The aim of this study was to identify risk factors for redialysis in postoperative patients with acute renal failure (ARF) who had previously been weaned from acute dialysis. Although recovery of renal function is anticipated in patients with ARF, no data have been reported on successful weaning from acute dialysis.
Retrospective observational case-control study in a 64-bed surgical ICU.
Success in discontinuing dialysis was defined as cessation from dialysis for at least 30 days. A total of 304 postoperative patients who underwent acute renal replacement therapy in a surgical ICU between July 2002 and April 2005 were included. SOFA score biochemical data and renal function parameters were assessed on the day after the last session of renal replacement therapy, designated as day 0 (D0).
We could wean 94 patients (30.9%) from acute dialysis for more than 5 days, and 64 of these (21.1%) were successfully weaned for at least 30days. The independent predictors for resuming dialysis within 30 days were: (a) longer duration of dialysis (OR 1.06), (b) higher SOFA score on D0 (OR 1.44), (c) oliguria (urine output <100cc/8h; OR 4.17) on D1, and (d) age over 65 years (OR 6.35). The area under the ROC curve was 0.880. Two-way analysis of variance with repeated measurements over time showed a larger decline in SOFA score and an increase in urine output in patients with successful cessation of dialysis. Kaplan-Meier analysis showed a significant difference in early resumption of dialysis between patients with or without oliguria at D0.
More than two-thirds of patients weaned from postoperative acute dialysis for more than 5 days were free of dialysis for at least 30 days. Less urine output, longer duration of dialysis, age over 65 years, and higher disease severity score are predictive of a patient's redialysis after initial weaning from acute dialysis.
本研究的目的是确定既往已从急性透析撤机的急性肾衰竭（ARF）术后患者再次透析的危险因素。尽管ARF患者预期肾功能会恢复，但尚无关于成功从急性透析撤机的数据报道。
在一家拥有64张床位的外科重症监护病房进行回顾性观察病例对照研究。
停止透析成功定义为停止透析至少30天。纳入了2002年7月至2005年4月期间在外科重症监护病房接受急性肾替代治疗的304例术后患者。在最后一次肾替代治疗后的次日（指定为第0天，D0）评估序贯器官衰竭评估（SOFA）评分、生化数据和肾功能参数。
我们能够使94例患者（30.9%）从急性透析撤机超过5天，其中64例（21.1%）成功撤机至少30天。30天内恢复透析的独立预测因素为：（a）透析时间更长（比值比[OR]1.06），（b）D0时SOFA评分更高（OR 1.44），（c）第1天（D1）少尿（尿量<100cc/8小时；OR 4.17），以及（d）年龄超过65岁（OR 6.35）。受试者工作特征（ROC）曲线下面积为0.880。随时间重复测量的双向方差分析显示，成功停止透析的患者SOFA评分下降幅度更大，尿量增加。Kaplan-Meier分析显示，D0时有无少尿的患者在早期恢复透析方面存在显著差异。
超过三分之二从术后急性透析撤机超过5天的患者至少30天未进行透析。尿量减少、透析时间延长、年龄超过65岁以及疾病严重程度评分更高是患者在从急性透析初次撤机后再次透析的预测因素。
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