Kee Youn Kyung, Kim Eun Jin, Park Kyoung Sook, Han Seung Gyu, Han In Mee, Yoon Chang Yun, Lee Eunyoung, Joo Young Su, Kim Dae Young, Lee Mi Jung, Park Jung Tak, Han Seung Hyeok, Yoo Tae-Hyun, Kim Beom Seok, Kang Shin-Wook, Choi Kyu Hun, Oh Hyung Jung
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2015 May;56(3):658-65. doi: 10.3349/ymj.2015.56.3.658.
Continuous renal replacement therapy (CRRT) has been established for critically ill acute kidney injury (AKI) patients. In addition, some centers consist of a specialized CRRT team (SCT) with physicians and nurses. To our best knowledge, however, ona a few studies have yet been carried out on the superiority of SCT management.
A total of 551 patients, who received CRRT between January 2008 and March 2009, were divided into two groups based on the controller of CRRT. The impact of the CRRT management on 28-day mortality was compared between two groups by Kaplan-Meier curve and Cox analysis.
During the study period, the number of filters used, down-time per day, and intensive care unit length of day were significantly higher in non-SCT group than in SCT group (6.2 hrs vs. 5.0 hrs, p=0.042; 5.0 hrs vs. 3.8 hrs, p<0.001; 27.5 days vs. 21.1 days, p=0.027, respectively), while net ultrafiltration rate was significantly lower in non-SCT group than SCT group (28.0 mL/kg/hr vs. 29.5 mL/kg/hr, p=0.043, respectively). In addition, 28-day mortality rate was significantly lower in SCT group than with non-SCT group (p=0.031). Moreover, Cox regression analysis showed that 28-day mortality rate was significantly lower in SCT control group, even after adjusting for age, gender, severity scores, biomarkers, risk, injury, failure, loss, and end-stage renal disease, and contributing factors (hazard ratio 0.91, p=0.046).
A well-trained CRRT team could be beneficial for mortality improvement of AKI patients requiring CRRT.
连续性肾脏替代治疗（CRRT）已应用于危重症急性肾损伤（AKI）患者。此外，一些中心组建了由医生和护士组成的专业CRRT团队（SCT）。然而，据我们所知，关于SCT管理优势的研究尚少。
将2008年1月至2009年3月期间接受CRRT治疗的551例患者，根据CRRT的管理者分为两组。通过Kaplan-Meier曲线和Cox分析比较两组CRRT管理对28天死亡率的影响。
研究期间，非SCT组使用的滤器数量、每日停机时间和重症监护病房住院天数均显著高于SCT组（分别为6.2小时对5.0小时，p = 0.042；5.0小时对3.8小时，p < 0.001；27.5天对21.1天，p = 0.027），而非SCT组的净超滤率显著低于SCT组（分别为28.0 mL/kg/小时对29.5 mL/kg/小时，p = 0.043）。此外，SCT组的28天死亡率显著低于非SCT组（p = 0.031）。而且，Cox回归分析显示，即使在调整年龄、性别、严重程度评分、生物标志物、风险、损伤、衰竭、丢失和终末期肾病及相关因素后，SCT对照组的28天死亡率仍显著较低（风险比0.91，p = 0.046）。
训练有素的CRRT团队可能有助于改善需要CRRT的AKI患者的死亡率。
