Durão Marcelino S, Monte Julio C M, Batista Marcelo C, Oliveira Moacir, Iizuka Ilson J, Santos Bento F, Pereira Virgilio G, Cendoroglo Miguel, Santos Oscar F P
Intensive Care Unit, Nephrology Support Group, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
Crit Care Med. 2008 Nov;36(11):3024-9. doi: 10.1097/CCM.0b013e31818b9100.
Continuous renal replacement therapy is commonly used in the treatment of acute kidney injury. Although the optimal anticoagulation system is not well defined, citrate has emerged as the most promising method. We evaluated the data of 143 patients with acute kidney injury subjected to citrate-based continuous venovenous hemodiafiltration.
Retrospective cohort study.
Intensive care unit of tertiary care private hospital.
Patients with acute kidney injury treated from February 2004 to July 2006.
None.
The main cause of acute kidney injury was sepsis (58%). The mean dialysis dose was 36.6 mL/kg/hr allowing for excellent metabolic control (last tests: creatinine, 1.1 mg/dL; urea, 46 mg/dL). No significant bleeding, severe electrolyte, or calcium disorders were observed. Of the 418 filters used, almost 28,000 hrs of treatment, hemofilter patency was 68% at 72 hrs. Hospital mortality was 59%, and 22% of survivors were dialysis-dependent at the time of discharge. Within our sample, we identified 21 patients with liver failure (mean prothrombin time index, 21% vs. 67%, p < 0.001). This group presented with a lesser median systemic ionized calcium level (1.06 vs. 1.12 mmol/L, p < 0.001) and similar mean total calcium level (8.5 vs. 8.6 mg/dL, not significant), compared with patients without liver failure. These subjects also showed acidemia (median pH, 7.31 vs. 7.40, p < 0.001); however, they exhibited higher levels of lactate (median 29 vs. 16 mg/dL, p < 0.001), chloride (mean 109 vs. 107 mEq/L, p = 0.045) and had a trend to higher mortality rate (76% vs. 56%).
Besides a trend toward higher mortality rate observed in the group with liver failure, we found that citrate-based continuous venovenous hemodiafiltration allowed an effective dialysis dose and reasonable filter patency.
连续性肾脏替代疗法常用于治疗急性肾损伤。尽管最佳抗凝系统尚未明确，但枸橼酸盐已成为最有前景的方法。我们评估了143例接受枸橼酸盐持续静静脉血液透析滤过治疗的急性肾损伤患者的数据。
回顾性队列研究。
三级护理私立医院的重症监护病房。
2004年2月至2006年7月期间接受治疗的急性肾损伤患者。
无。
急性肾损伤的主要原因是脓毒症（58%）。平均透析剂量为36.6 mL/kg/小时，实现了良好的代谢控制（最后检测结果：肌酐1.1 mg/dL；尿素46 mg/dL）。未观察到明显出血、严重电解质紊乱或钙紊乱。在使用的418个滤器中，经过近28000小时的治疗，72小时时血液滤过器通畅率为68%。医院死亡率为59%，22%的幸存者出院时依赖透析。在我们的样本中，我们确定了21例肝功能衰竭患者（平均凝血酶原时间指数，21%对67%，p<0.001）。与无肝功能衰竭的患者相比，该组患者的中位全身离子钙水平较低（1.06对1.12 mmol/L，p<0.001），平均总钙水平相似（8.5对8.6 mg/dL，无显著差异）。这些患者还表现为酸血症（中位pH值，7.31对7.40，p<0.001）；然而，他们的乳酸水平较高（中位值29对16 mg/dL，p<0.001），氯水平较高（平均109对107 mEq/L，p = 0.045），且死亡率有升高趋势（76%对56%）。
除了肝功能衰竭组观察到死亡率有升高趋势外，我们发现枸橼酸盐持续静静脉血液透析滤过可实现有效的透析剂量和合理的滤器通畅率。
