Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Am J Surg. 2010 Apr;199(4):466-76. doi: 10.1016/j.amjsurg.2009.01.007. Epub 2009 Apr 17.
In postsurgical acute renal failure patients with moderate unstable hemodynamics or fluid overload, the choice of dialysis modality is difficult. This study was performed to compare the outcomes between the sustained low-efficiency dialysis (SLED) and continuous veno-venous hemofiltration (CVVH) in these patients.
Sequential postsurgical acute renal failure patients undergoing acute dialysis with CVVH (2002-2003), or SLED (2004-2005) as a result of severe fluid overload or moderately unstable hemodynamics were analyzed. Multivariate analyses of comorbidity, disease severity before initiating dialysis, biochemical measurements, and hemodynamic parameters for 3 days after the first dialysis session were performed by fitting multiple logistic regression models to predict patient's 30-day after hospital discharge (AHD) mortality.
Among the 101 recruited patients, 38 received SLED and the rest received CVVH. The 30-day AHD mortality was 62.4%. The independent risk factors of 30-day AHD mortality included older age (P = .008), lower first postdialysis mean arterial pressure (MAP) (P = .021), higher first postdialysis blood urea nitrogen level (P = .009), and absence of a history of hypertension (P = .002). A further linear regression analysis found that dialysis using SLED was associated with higher first postdialysis MAP (P = .003).
Among the postsurgical patients requiring acute dialysis with severe fluid overload or moderately unstable hemodynamics, the patients treated with SLED had a higher first postdialysis MAP than those treated with CVVH, which led to lower mortality. Further multicenter randomized clinical trials of larger sample size are needed to compare the effects of SLED and CVVH on the outcomes of postsurgical acute dialysis patients.
在伴有中度不稳定血流动力学或液体超负荷的术后急性肾衰竭患者中，透析方式的选择较为困难。本研究旨在比较持续低效透析（SLED）和连续性静脉-静脉血液滤过（CVVH）在这些患者中的疗效。
分析了因严重液体超负荷或中度不稳定血流动力学而接受急性透析的连续术后急性肾衰竭患者，他们分别接受 CVVH（2002-2003 年）或 SLED（2004-2005 年）治疗。通过拟合多元逻辑回归模型，对合并症、透析前疾病严重程度、生化指标以及首次透析后 3 天的血流动力学参数进行多变量分析，以预测患者出院后 30 天（AHD）的死亡率。
在纳入的 101 例患者中，38 例接受 SLED 治疗，其余接受 CVVH 治疗。30 天 AHD 死亡率为 62.4%。30 天 AHD 死亡率的独立危险因素包括年龄较大（P=0.008）、首次透析后平均动脉压较低（P=0.021）、首次透析后血尿素氮水平较高（P=0.009）以及无高血压病史（P=0.002）。进一步的线性回归分析发现，使用 SLED 进行透析与较高的首次透析后 MAP 相关（P=0.003）。
在需要急性透析治疗严重液体超负荷或中度不稳定血流动力学的术后患者中，与接受 CVVH 治疗的患者相比，接受 SLED 治疗的患者首次透析后的 MAP 更高，死亡率更低。需要进行更大样本量的多中心随机临床试验，以比较 SLED 和 CVVH 对术后急性透析患者结局的影响。
