Mehta Ravindra L
Department of Medicine, University of California San Diego, San Diego, CA 92103, USA.
Nat Clin Pract Nephrol. 2009 Jan;5(1):10-1. doi: 10.1038/ncpneph0988. Epub 2008 Nov 11.
This Practice Point commentary discusses the findings from the secondary analysis of a large systematic cohort study of critically ill patients that evaluated the influence of fluid overload on outcomes from acute kidney injury (AKI). Payen et al. reported a 36% incidence of AKI among the 3,147 patients enrolled in the Sepsis Occurrence in Acutely Ill Patients (SOAP) study. Mortality rate at 60 days was more than twofold higher among patients who had AKI than among those without AKI. Among patients with AKI, mortality rates were increased in patients with oliguria and in those treated with renal replacement therapy. A positive fluid balance was an independent risk factor for 60-day mortality. The interpretation and implications of these findings for clinical practice are highlighted in this commentary. Fluid balance is probably an important factor that determines outcomes in patients with AKI who are in an intensive care unit, but additional studies are required to confirm these findings.
本实践要点评论讨论了一项针对危重症患者的大型系统性队列研究的二次分析结果，该研究评估了液体超负荷对急性肾损伤（AKI）预后的影响。帕扬等人报告称，在“急性病患者脓毒症发生率（SOAP）研究”纳入的3147例患者中，AKI的发生率为36%。发生AKI的患者60天死亡率比未发生AKI的患者高出两倍多。在患有AKI的患者中，少尿患者和接受肾脏替代治疗的患者死亡率增加。液体正平衡是60天死亡率的独立危险因素。本评论强调了这些发现对临床实践的解读及意义。液体平衡可能是决定重症监护病房中AKI患者预后的一个重要因素，但还需要更多研究来证实这些发现。
