CRRT 中的溶质清除：规定剂量与实际给予剂量。
Solute clearance in CRRT: prescribed dose versus actual delivered dose.
机构信息
Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
出版信息
Nephrol Dial Transplant. 2012 Mar;27(3):952-6. doi: 10.1093/ndt/gfr480. Epub 2011 Sep 5.
BACKGROUND
Substantial efforts have been made toward defining the dose threshold of continuous renal replacement therapy (CRRT) associated with improved survival in critically ill patients with acute kidney injury. Published studies have used prescribed effluent rates, expressed as total effluent volume (TEV) per weight and unit time (mL/kg/h), as a surrogate for dose. The purpose of this study was to compare differences in CRRT dose based on prescribed effluent rate, measured TEV and direct measurement of urea and creatinine clearance.
METHODS
We analyzed data that had been prospectively collected on 200 patients enrolled in a randomized trial comparing survival with a prescribed effluent rate of 20 mL/kg/h (standard dose) to 35 mL/kg/h (high dose) using pre-dilution continuous venovenous hemodiafiltration (CVVHDF). Filters were changed every 72 h. Blood urea nitrogen (BUN), serum creatinine (SCr), effluent urea nitrogen (EUN) and effluent creatinine (ECr) were collected daily. Actual delivered dose was calculated as: (EUN/BUN)*TEV for urea and (ECr/SCr)*TEV for creatinine. Data were available for 165 patients.
RESULTS
In both groups, prescribed dose differed significantly from the measured TEV dose (P < 0.001). In the standard dose group, there was no difference between the measured TEV dose and actual delivered urea and creatinine clearances. However, in the high-dose group, measured TEV dose differed significantly from delivered urea clearance by 7.1% (P < 0.001) and creatinine clearance by 13.9% (P < 0.001).
CONCLUSIONS
Dose based on prescribed effluent rate or measured TEV is a poor substitute for actual CVVHDF creatinine and urea clearance.
背景
大量研究致力于定义连续肾脏替代治疗（CRRT）的剂量阈值，以改善急性肾损伤危重症患者的生存率。已发表的研究使用规定的流出率，即单位时间和体重的总流出量（mL/kg/h），作为剂量的替代指标。本研究旨在比较基于规定流出率、测量的TEV 和直接测量的尿素和肌酐清除率的 CRRT 剂量差异。
方法
我们分析了一项前瞻性研究的数据，该研究纳入了 200 名患者，这些患者被随机分配到接受 20 mL/kg/h（标准剂量）或 35 mL/kg/h（高剂量）的预稀释连续静脉-静脉血液透析滤过（CVVHDF）治疗的组中。每 72 小时更换一次过滤器。每天收集血液尿素氮（BUN）、血清肌酐（SCr）、流出液尿素氮（EUN）和流出液肌酐（ECr）。实际给予的剂量计算为：尿素的（EUN/BUN）*TEV 和肌酐的（ECr/SCr）*TEV。165 名患者的数据可用。
结果
在两组中，规定的剂量与测量的 TEV 剂量差异显著（P < 0.001）。在标准剂量组中，测量的 TEV 剂量与实际给予的尿素和肌酐清除率无差异。然而，在高剂量组中，测量的 TEV 剂量与给予的尿素清除率相差 7.1%（P < 0.001），与肌酐清除率相差 13.9%（P < 0.001）。
结论
基于规定流出率或测量的 TEV 的剂量是实际 CVVHDF 肌酐和尿素清除率的不良替代指标。
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