Albino Bianca Ballarin, Balbi André Luis, Abrão Juliana Maria Gera, Ponce Daniela
Internal Medicine, University São Paulo State-UNESP, Distrito de Rubiao Junior, Botucatu, São Paulo, Brazil.
Artif Organs. 2015 May;39(5):423-31. doi: 10.1111/aor.12408. Epub 2015 Apr 10.
Prolonged intermittent renal replacement therapy (PIRRT) has emerged as an alternative to continuous renal replacement therapy in the management of acute kidney injury (AKI) patients. This trial aimed to compare the dialysis complications occurring during different durations of PIRRT sessions in critically ill AKI patients. We included patients older than 18 years with AKI associated with sepsis admitted to the intensive care unit and using noradrenaline doses ranging from 0.3 to 0.7 µg/kg/min. Patients were divided into two groups randomly: in G1, 6-h sessions were performed, and in G2, 10-h sessions were performed. Seventy-five patients were treated with 195 PIRRT sessions for 18 consecutive months. The prevalence of hypotension, filter clotting, hypokalemia, and hypophosphatemia was 82.6, 25.3, 20, and 10.6%, respectively. G1 was composed of 38 patients treated with 100 sessions, whereas G2 consisted of 37 patients treated with 95 sessions. G1 and G2 were similar in male predominance (65.7 vs. 75.6%, P = 0.34), age (63.6 ± 14 vs. 59.9 ± 15.5 years, P = 0.28) and Sequential Organ Failure Assessment score (SOFA; 13.1 ± 2.4 vs. 14.2 ± 3.0, P = 0.2). There was no significant difference between the two groups in hypotension (81.5 vs. 83.7%, P = 0.8), filter clotting (23.6 vs. 27%, P = 0.73), hypokalemia (13.1 vs. 8.1%, P = 0.71), and hypophosphatemia (18.4 vs. 21.6%, P = 0.72). However, the group treated with sessions of 10 h were refractory to clinical measures for hypotension, and dialysis sessions were interrupted more often (9.5 vs. 30.1%, P = 0.03). Metabolic control and fluid balance were similar between G1 and G2 (blood urea nitrogen [BUN]: 81 ± 30 vs. 73 ± 33 mg/dL, P = 1.0; delivered Kt/V: 1.09 ± 0.24 vs. 1.26 ± 0.26, P = 0.09; actual ultrafiltration: 1731 ± 818 vs. 2332 ± 947 mL, P = 0.13) and fluid balance (-731 ± 125 vs. -652 ± 141 mL, respectively) . In conclusion, intradialysis hypotension was common in AKI patients treated with PIRRT. There was no difference in the prevalence of dialysis complications in patients undergoing different durations of PIRRT.
延长间歇性肾脏替代疗法（PIRRT）已成为急性肾损伤（AKI）患者管理中持续肾脏替代疗法的替代方案。本试验旨在比较重症AKI患者在不同时长PIRRT治疗期间发生的透析并发症。我们纳入了入住重症监护病房、年龄大于18岁、患有与脓毒症相关的AKI且去甲肾上腺素剂量为0.3至0.7µg/kg/min的患者。患者被随机分为两组：G1组进行6小时治疗，G2组进行10小时治疗。75例患者接受了195次PIRRT治疗，持续18个月。低血压、滤器凝血、低钾血症和低磷血症的发生率分别为82.6%、25.3%、20%和10.6%。G1组由38例患者接受100次治疗组成，而G2组由37例患者接受95次治疗组成。G1组和G2组在男性占优势方面（65.7%对75.6%，P = 0.34）、年龄（63.6±14岁对59.9±15.5岁，P = 0.28）和序贯器官衰竭评估评分（SOFA；13.1±2.4对14.2±3.0，P = 0.2）方面相似。两组在低血压（81.5%对83.7%，P = 0.8）、滤器凝血（23.6%对27%，P = 0.73）、低钾血症（13.1%对8.1%，P = 0.71）和低磷血症（18.4%对21.6%，P = 0.72）方面无显著差异。然而，接受10小时治疗的组对低血压的临床措施难治，且透析治疗中断更频繁（9.5%对30.1%，P = 0.03）。G1组和G2组之间的代谢控制和液体平衡相似（血尿素氮[BUN]：81±30对73±33mg/dL，P = 1.0；透析剂量Kt/V：1.09±0.24对1.26±0.26，P = 0.09；实际超滤量：1731±818对2332±947mL，P = 0.13）以及液体平衡（分别为-731±125对-652±141mL）。总之，PIRRT治疗的AKI患者透析中低血压很常见。接受不同时长PIRRT治疗的患者透析并发症发生率无差异。
