Bae Woo Kvun, Lim Dae Hun, Jeong Ji Min, Jung Hae Young, Kim Seong Ku, Park Jeong Woo, Bae Eun Hui, Ma Seong Kwon, Kim Soo Wan, Kim Nam Ho, Choi Ki Chul
Department of Internal Medicine, Chonnam National University Medical School, Dong-gu, Gwangju 501-757, Korea.
Korean J Intern Med. 2008 Jun;23(2):58-63. doi: 10.3904/kjim.2008.23.2.58.
BACKGROUND/AIMS: Continuous renal replacement therapy (CRRT) has been widely used for treating critically ill patients with acute kidney injury (AKI). Whether CRRT is better than intermittent hemodialysis for the treatment of AKI remains controversial. We sought to identify the clinical features that can predict survival for the patients who are treated with CRRT.
We analyzed the data of 125 patients who received CRRT between 2005 and 2007. We identified the demographic variables, the underlying diagnoses, the duration of CRRT, the mean arterial blood pressure (ABP) and the Simplified Acute Physiology Score (SAPS) II. The classification/staging system for acute kidney injury (AKI) was applied to all the patients, who were then divided into stage 1-3 subgroups.
The average age of the patients was 61.414.3 years and the mortality rate was 60% (75 of 125 patients). The survivors had a significantly higher mean ABP and a higher mean serum bicarbonate level, which were measured the day after CRRT, than the nonsurvivors (86.723.7 vs. 69.224.6 mm Hg, respectively, 21.43.5 vs. 16.45.4 mmol/L, respectively,; p<0.05 for each). The stage 3 AKI patients showed the worst parameters for the SAPS II score and the serum levels of creatinine and blood urea nitrogen. The mortality rate was higher for the stage 3 subgroup than the other groups (70.5%, p<0.05).
The patients with AKI and who require CRRT continue to have a high mortality rate. A higher mean ABP and a higher serum bicarbonate level measured the day after CRRT may predict a more favorable prognosis. The staging system for AKI can improve the ability to predict the outcomes of CRRT patients.
背景/目的：连续性肾脏替代治疗（CRRT）已广泛用于治疗急性肾损伤（AKI）的危重病患者。CRRT治疗AKI是否优于间歇性血液透析仍存在争议。我们试图确定能够预测接受CRRT治疗患者生存情况的临床特征。
我们分析了2005年至2007年间接受CRRT治疗的125例患者的数据。我们确定了人口统计学变量、基础诊断、CRRT持续时间、平均动脉血压（ABP）和简化急性生理学评分（SAPS）II。将急性肾损伤（AKI）的分类/分期系统应用于所有患者，然后将其分为1-3期亚组。
患者的平均年龄为61.4±14.3岁，死亡率为60%（125例患者中的75例）。与未存活者相比，存活者在CRRT后第二天测量的平均ABP和平均血清碳酸氢盐水平显著更高（分别为86.7±23.7与69.2±24.6mmHg，21.4±3.5与16.4±5.4mmol/L，每组p<0.05）。3期AKI患者的SAPS II评分以及肌酐和血尿素氮血清水平参数最差。3期亚组的死亡率高于其他组（70.5%，p<0.05）。
需要CRRT治疗的AKI患者死亡率仍然很高。CRRT后第二天测量的较高平均ABP和较高血清碳酸氢盐水平可能预示预后较好。AKI分期系统可以提高预测CRRT患者预后的能力。
