Kidney Disease Centre, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China.
Nephrol Dial Transplant. 2012 Mar;27(3):967-73. doi: 10.1093/ndt/gfr486. Epub 2011 Sep 2.
Acute kidney injury (AKI) is a major complication in patients with sepsis and is an independent predictor of mortality. However, the optimal intensity of renal replacement therapy for such patients is still controversial.
From 1 January 2004 to 30 September 2009, we randomly assigned 280 patients with sepsis and AKI to continuous renal replacement therapy by high-volume hemofiltration (50 mL/kg/h, HVHF) or extra high-volume hemofiltration (85 mL/kg/h, EHVHF). The primary study outcome was death from any cause within 28, 60 and 90 days. Results were analyzed by univariate and multivariate methods and by Kaplan-Meier survival curves.
A total of 141 patients were given EHVHF and 139 were given HVHF. The two groups had similar baseline characteristics and received treatment for an average of 9.38 days (EHVHF group) and 8.88 days (HVHF group). There were no significant differences between the groups in number of deaths at 28, 60 or 90 days. There were also no differences between the groups in renal outcome of survivors at 90 days. Multivariate analysis indicated that inotropic support by norepinephrine, time in hospital of >7 days, blood platelet count <8 × 10(9)/L, Acute Physiological and Chronic Health Evaluation (APACHE) II score >25, total bilirubin >100 μmol/L, prothrombin time >18 s, serum creatinine <250 μmol/L and blood urea nitrogen >20 mmol/L were independent risk factors for death at 90 days after initiation of renal replacement therapy.
In patients with sepsis and AKI, increasing the intensity of renal replacement therapy from 50 (HVHF) to 85 mL/kg/h (EHVHF) had no effect on survival at 28 and 90 days.
急性肾损伤（AKI）是脓毒症患者的主要并发症，也是死亡率的独立预测因子。然而，此类患者的最佳肾脏替代治疗强度仍存在争议。
2004 年 1 月 1 日至 2009 年 9 月 30 日，我们将 280 名脓毒症合并 AKI 患者随机分为高容量血液滤过（50ml/kg/h，HVHF）或超高容量血液滤过（85ml/kg/h，EHVHF）组进行连续肾脏替代治疗。主要研究终点为 28、60 和 90 天的任何原因死亡。采用单因素和多因素方法以及 Kaplan-Meier 生存曲线进行分析。
共 141 例患者接受 EHVHF，139 例患者接受 HVHF。两组患者的基线特征相似，平均接受治疗 9.38 天（EHVHF 组）和 8.88 天（HVHF 组）。28、60 和 90 天时，两组的死亡率无显著差异。90 天存活者的肾脏结局也无差异。多因素分析表明，去甲肾上腺素的正性肌力支持、住院时间>7 天、血小板计数<8×10（9）/L、急性生理和慢性健康评分（APACHE）Ⅱ评分>25、总胆红素>100μmol/L、凝血酶原时间>18s、血清肌酐<250μmol/L、血尿素氮>20mmol/L 是肾脏替代治疗开始后 90 天死亡的独立危险因素。
在脓毒症合并 AKI 患者中，将肾脏替代治疗强度从 50（HVHF）增加到 85ml/kg/h（EHVHF）对 28 和 90 天的生存率没有影响。
