使用 2 小时肌酐清除率指导连续肾脏替代治疗的停止。

Use of 2-hour creatinine clearance to guide cessation of continuous renal replacement therapy.

机构信息

National SpR Academic Fellowship Programme, St Vincent's University Hospital, Dublin 4, Ireland.

出版信息

J Crit Care. 2012 Dec;27(6):744.e1-5. doi: 10.1016/j.jcrc.2012.08.012. Epub 2012 Oct 24.

DOI:10.1016/j.jcrc.2012.08.012

PMID:23102534

Abstract

PURPOSE

A simple test that could guide successful cessation of continuous renal replacement therapy (CRRT) in critically ill patients would be clinically useful. This study aimed to investigate whether a 2-hour creatinine clearance (2h-CrCl) measurement could more accurately predict successful cessation of CRRT than serum creatinine or urine output alone.

MATERIALS AND METHODS

This retrospective study identified all patients admitted to a university teaching hospital intensive care unit who received CRRT and had a 2h-CrCl measurement performed in the 12 hours preceding CRRT cessation. The ability of 2h-CrCl to predict successful discontinuation of CRRT was compared to other renal indices.

RESULTS

Of 85 patients who had 2h-CrCl performed prior to CRRT cessation 53 (62.4%)(success group) remained dialysis free 7 days after CRRT cessation. 2h-CrCl was a better predictor of remaining CRRT free at day 7 (OR, 1.108 [1.05-1.17] per 1 mL/min increase in 2 hours CrCl, P < .001) than urine output, serum creatinine or age. A 2h-CrCl value of 23 mL/min had a sensitivity, specificity and positive predictive value for remaining CRRT free at day 7 of 75.5%, 84.4%, and 88.8%, respectively.

CONCLUSION

2h-CrCl may be a useful measurement to help guide discontinuation from CRRT.

摘要

目的

对于危重症患者，一种能够指导连续肾脏替代治疗（CRRT）成功停止的简单测试将具有临床应用价值。本研究旨在探讨 2 小时肌酐清除率（2h-CrCl）测量是否比单独的血肌酐或尿量更能准确预测 CRRT 的成功停止。

材料和方法

本回顾性研究纳入了所有在大学教学医院重症监护病房接受 CRRT 治疗并在停止 CRRT 前 12 小时内进行 2h-CrCl 测量的患者。比较了 2h-CrCl 与其他肾功能指标预测成功停止 CRRT 的能力。

结果

在 85 例接受 2h-CrCl 测量以预测停止 CRRT 后 7 天是否仍需透析的患者中，53 例（62.4%）（成功组）在停止 CRRT 后 7 天无需继续透析。2h-CrCl 是预测停止 CRRT 后 7 天仍无需透析的更好指标（OR，每增加 1 毫升/分钟 2h-CrCl，增加 1.108[1.05-1.17]，P<0.001），优于尿量、血肌酐或年龄。2h-CrCl 值为 23 毫升/分钟时，对停止 CRRT 后 7 天仍无需透析的预测敏感性、特异性和阳性预测值分别为 75.5%、84.4%和 88.8%。