Department of Internal Medicine, Marshfield Clinic Marshfield, Marshfield, WI 52713, USA.
Ren Fail. 2011;33(7):698-706. doi: 10.3109/0886022X.2011.589945.
Acute kidney injury (AKI) requiring dialysis commonly occurs in critically ill patients and is associated with high mortality. Factors impacting outcomes of individuals with AKI who underwent continuous renal replacement therapy (CRRT), including early versus late initiation and duration of CRRT, were examined.
Survival and recovery of renal function for patients with AKI in the intensive care unit were retrospectively examined over a 7-year period. Factors associated with mortality and renal recovery were analyzed based on severity of illness as defined by Cleveland Clinic Foundation (CCF) score. Univariate and multivariate logistic regression analysis with backward elimination was performed to determine the most significant risk factors.
Of patients who underwent CRRT, 230/330 met inclusion criteria. During index admission 112/230 (48.7%) patients died. Median survival was 15.5 days [95% confidence interval (12.0, 18.0)]. Among survivors, renal recovery occurred in 84/118 (71.2%). Renal recovery overall was observed in 90/230 subjects (39.13%). A higher baseline CCF score correlated with higher mortality and lower probability of renal recovery. Patients initiated on CRRT > 6 days after AKI diagnosis had significantly higher mortality compared with those initiated earlier (odds ratio = 11.66, p = 0.0305). Patients receiving CRRT >10 days had a higher mortality rate compared with those with shorter exposure (71.3% vs. 45.5%, respectively, p = 0.012).
CRRT remains an important dialysis modality in hemodynamically unstable patients with AKI. Mortality in these patients continues to be high. Renal recovery is high in survivors. Delay in initiation and length of CRRT exposure may portend poorer prognosis.
急性肾损伤（AKI）需要透析的情况在重症患者中很常见，与高死亡率相关。本研究检查了接受连续肾脏替代治疗（CRRT）的 AKI 患者的预后影响因素，包括开始治疗的时间（早期或晚期）和 CRRT 的持续时间。
回顾性分析了 7 年间 ICU 中 AKI 患者的生存和肾功能恢复情况。根据克利夫兰诊所基金会（CCF）评分定义的疾病严重程度分析了与死亡率和肾功能恢复相关的因素。采用向后消除的单变量和多变量逻辑回归分析确定最重要的危险因素。
在接受 CRRT 的患者中，230/330 例符合纳入标准。在指数住院期间，112/230 例（48.7%）患者死亡。中位生存时间为 15.5 天[95%置信区间（12.0，18.0）]。在幸存者中，84/118 例（71.2%）肾功能恢复。230 例患者中整体肾功能恢复率为 90/230（39.13%）。较高的基线 CCF 评分与较高的死亡率和较低的肾功能恢复率相关。AKI 诊断后 6 天以上开始 CRRT 的患者死亡率明显高于早期开始的患者（比值比=11.66，p=0.0305）。接受 CRRT>10 天的患者死亡率高于暴露时间较短的患者（分别为 71.3%和 45.5%，p=0.012）。
CRRT 仍然是血流动力学不稳定 AKI 患者的重要透析方式。这些患者的死亡率仍然很高。幸存者的肾功能恢复率较高。开始治疗的延迟和 CRRT 暴露时间的延长可能预示着预后较差。
