持续性低效透析在急性肾损伤危重症患者管理中的血液动力学耐受性和可行性。
The hemodynamic tolerability and feasibility of sustained low efficiency dialysis in the management of critically ill patients with acute kidney injury.
机构信息
Department of Medicine, University of Toronto, Toronto, ON, Canada.
出版信息
BMC Nephrol. 2010 Nov 25;11:32. doi: 10.1186/1471-2369-11-32.
BACKGROUND
Minimization of hemodynamic instability during renal replacement therapy (RRT) in patients with acute kidney injury (AKI) is often challenging. We examined the relative hemodynamic tolerability of sustained low efficiency dialysis (SLED) and continuous renal replacement therapy (CRRT) in critically ill patients with AKI. We also compared the feasibility of SLED administration with that of CRRT and intermittent hemodialysis (IHD).
METHODS
This cohort study encompassed four critical care units within a single university-affiliated medical centre. 77 consecutive critically ill patients with AKI who were treated with CRRT (n = 30), SLED (n = 13) or IHD (n = 34) and completed at least two RRT sessions were included in the study. Overall, 223 RRT sessions were analyzed. Hemodynamic instability during a given session was defined as the composite of a > 20% reduction in mean arterial pressure or any escalation in pressor requirements. Treatment feasibility was evaluated based on the fraction of the prescribed therapy time that was delivered. An interrupted session was designated if < 90% of the prescribed time was administered. Generalized estimating equations were used to compare the hemodynamic tolerability of SLED vs CRRT while accounting for within-patient clustering of repeated sessions and key confounders.
RESULTS
Hemodynamic instability occurred during 22 (56.4%) SLED and 43 (50.0%) CRRT sessions (p = 0.51). In a multivariable analysis that accounted for clustering of multiple sessions within the same patient, the odds ratio for hemodynamic instability with SLED was 1.20 (95% CI 0.58-2.47), as compared to CRRT. Session interruption occurred in 16 (16.3), 30 (34.9) and 11 (28.2) of IHD, CRRT and SLED therapies, respectively.
CONCLUSIONS
In critically ill patients with AKI, the administration of SLED is feasible and provides comparable hemodynamic control to CRRT.
背景
在急性肾损伤（AKI）患者的肾脏替代治疗（RRT）中，减少血液动力学不稳定通常具有挑战性。我们检查了持续低效率透析（SLED）和连续肾脏替代治疗（CRRT）在 AKI 危重患者中的相对血液动力学耐受性。我们还比较了 SLED 给药的可行性与 CRRT 和间歇性血液透析（IHD）的可行性。
方法
这项队列研究包括一个大学附属医院的四个重症监护病房。77 例接受 CRRT（n=30）、SLED（n=13）或 IHD（n=34）治疗且至少完成两次 RRT 治疗的 AKI 危重患者连续纳入研究。总共分析了 223 次 RRT 治疗。一个给定的 RRT 治疗期间的血液动力学不稳定被定义为平均动脉压降低>20%或任何升压需求增加的复合指标。治疗的可行性是根据所规定的治疗时间的分数来评估的。如果<90%的规定时间被给予，则指定为中断的 RRT 治疗。使用广义估计方程来比较 SLED 与 CRRT 的血液动力学耐受性，同时考虑到重复 RRT 治疗期间的患者内聚类和关键混杂因素。
结果
22 次 SLED（56.4%）和 43 次 CRRT（50.0%）治疗期间发生血液动力学不稳定（p=0.51）。在一项多变量分析中，该分析考虑了同一患者中多个 RRT 治疗期间的聚类，与 CRRT 相比，SLED 发生血液动力学不稳定的优势比为 1.20（95%CI 0.58-2.47）。IHD、CRRT 和 SLED 治疗分别中断 16（16.3%）、30（34.9%）和 11（28.2%）次。
结论
在 AKI 危重患者中，SLED 的给药是可行的，并且与 CRRT 相比提供了相当的血液动力学控制。
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