Triverio Pierre-Alain, Martin Pierre-Yves, Romand Jacques, Pugin Jerome, Perneger Thomas, Saudan Patrick
Service de Néphrologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
Nephrol Dial Transplant. 2009 Jul;24(7):2186-9. doi: 10.1093/ndt/gfp072. Epub 2009 Feb 19.
Data on the long-term survival and renal function of patients with acute kidney injury (AKI) treated with continuous renal replacement therapy are scarce.
We investigated the 3-year survival and need for chronic dialysis in critically ill patients, who had survived an episode of AKI requiring continuous renal replacement therapy.
A total of 206 ICU patients with AKI were randomized in a trial comparing haemofiltration versus haemodiafiltration. Of these, 95 (46%) survived at 90 days. Post-discharge information relating to 3-year survival and renal function was successfully obtained in 89 (94%) of the patients. Of the 89 patients studied, chronic kidney disease (CKD) was present in 32 subjects from the onset, and CKD developed de novo in 25 patients following AKI. End-stage renal disease (ESRD) developed in 9 patients (of whom 8 had pre-existing CKD) and 29 patients died. Three-year survival was 67% overall; the mortality at 3 years was 50% for those with pre-existing kidney disease, and 71 and 82% for those with de novo and without CKD, respectively.
After an episode of AKI necessitating a continuous renal replacement therapy, rapid progression to ESKD is commonly observed in patients with pre-existing chronic renal impairment. Medical care with an emphasis on nephroprotection is necessary in these patients.
关于接受持续肾脏替代治疗的急性肾损伤（AKI）患者的长期生存及肾功能的数据稀缺。
我们调查了在经历了一次需要持续肾脏替代治疗的AKI发作后存活下来的危重症患者的3年生存率及慢性透析需求。
共有206例AKI的重症监护病房患者被随机分组至一项比较血液滤过与血液透析滤过的试验中。其中，95例（46%）在90天时存活。89例（94%）患者成功获得了出院后3年生存及肾功能的信息。在接受研究的89例患者中，32例从一开始就存在慢性肾脏病（CKD），25例患者在AKI后新发CKD。9例患者发展为终末期肾病（ESRD）（其中8例原有CKD），29例患者死亡。总体3年生存率为67%；原有肾病患者3年死亡率为50%，新发CKD和无CKD患者的3年死亡率分别为71%和82%。
在经历一次需要持续肾脏替代治疗的AKI发作后，原有慢性肾功能损害的患者中通常可观察到快速进展至终末期肾病。对这些患者而言，进行着重肾脏保护作用的医疗护理很有必要。
