Renal Division, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC.
Am J Nephrol. 2011;34(2):95-103. doi: 10.1159/000329082. Epub 2011 Jun 17.
Information is limited regarding the outcomes of patients with preexisting chronic kidney disease (CKD) who develop dialysis-requiring acute kidney injury.
131 adult patients with advanced CKD who received emergent hemodialysis from January to June in 2002 were recruited and monitored for all-cause mortality and end-stage renal disease until the end of 2007.
Among patients investigated, 21 (16%) were successfully withdrawn from acute hemodialysis after an average of 8 sessions of dialysis therapy (range: 1-44). Multivariate analysis revealed that larger kidney size (odds ratio, OR = 1.755, p = 0.018), lower predialysis creatinine (OR = 0.722, p = 0.002), and non-diabetes (OR = 0.271, p = 0.037) were predictors for withdrawal. After 5 years, all patients in the non-withdrawal group remained on chronic dialysis, whereas only 8/21 (38%) patients in the withdrawal group developed end-stage renal disease. Cox's analysis showed that age (hazard ratio, HR = 1.043, p < 0.0001), prerenal azotemia (HR = 1.040, p = 0.002), and adjusted propensity score for assigning to dialysis withdrawal (HR = 6.819, p = 0.008) were associated with mortality. Withdrawal from acute dialysis was not related to long-term mortality (p = 0.34).
Among the advanced CKD patients, predictors of the successful weaning from acute dialysis were non-diabetes, larger kidney size and lower serum creatinine levels. The strategy of removal from emergent dialysis was not related to long-term mortality.
对于患有需要透析的急性肾损伤的慢性肾脏病（CKD）患者的预后信息有限。
2002 年 1 月至 6 月期间，招募了 131 名患有晚期 CKD 的成年患者，这些患者接受紧急血液透析治疗，并在 2007 年底前对所有原因死亡率和终末期肾病进行监测。
在所研究的患者中，有 21 名（16%）在接受平均 8 次透析治疗（范围：1-44 次）后成功地从急性血液透析中撤机。多变量分析显示，更大的肾脏大小（优势比，OR = 1.755，p = 0.018）、更低的透析前肌酐（OR = 0.722，p = 0.002）和非糖尿病（OR = 0.271，p = 0.037）是撤机的预测因素。5 年后，非撤机组的所有患者均继续接受慢性透析治疗，而撤机组中仅 8/21（38%）名患者发展为终末期肾病。Cox 分析表明，年龄（危险比，HR = 1.043，p < 0.0001）、肾前性氮血症（HR = 1.040，p = 0.002）和调整后的透析撤机倾向评分（HR = 6.819，p = 0.008）与死亡率相关。急性透析撤机与长期死亡率无关（p = 0.34）。
在晚期 CKD 患者中，急性透析成功撤机的预测因素是非糖尿病、更大的肾脏大小和更低的血清肌酐水平。从紧急透析中撤机的策略与长期死亡率无关。
