使用单程批量设备对重症急性肾损伤癌症患者进行间歇性血液透析的评估。
Evaluation of Intermittent Hemodialysis in Critically Ill Cancer Patients with Acute Kidney Injury Using Single-Pass Batch Equipment.
作者信息
Torres da Costa E Silva Verônica, Costalonga Elerson C, Oliveira Ana Paula Leandro, Hung James, Caires Renato Antunes, Hajjar Ludhmila Abrahão, Fukushima Julia T, Soares Cilene Muniz, Bezerra Juliana Silva, Oikawa Luciane, Yu Luis, Burdmann Emmanuel A
机构信息
Nephrology Division, Sao Paulo State Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil.
Intensive Care Unit Department, Sao Paulo State Cancer Institute, University of Sao Paulo School Medical School, Sao Paulo, Sao Paulo, Brazil.
出版信息
PLoS One. 2016 Mar 3;11(3):e0149706. doi: 10.1371/journal.pone.0149706. eCollection 2016.
BACKGROUND
Data on renal replacement therapy (RRT) in cancer patients with acute kidney injury (AKI) in the intensive care unit (ICU) is scarce. The aim of this study was to assess the safety and the adequacy of intermittent hemodialysis (IHD) in critically ill cancer patients with AKI.
METHODS AND FINDINGS
In this observational prospective cohort study, 149 ICU cancer patients with AKI were treated with 448 single-pass batch IHD procedures and evaluated from June 2010 to June 2012. Primary outcomes were IHD complications (hypotension and clotting) and adequacy. A multiple logistic regression was performed in order to identify factors associated with IHD complications (hypotension and clotting). Patients were 62.2 ± 14.3 years old, 86.6% had a solid cancer, sepsis was the main AKI cause (51%) and in-hospital mortality was 59.7%. RRT session time was 240 (180-300) min, blood/dialysate flow was 250 (200-300) mL/min and UF was 1000 (0-2000) ml. Hypotension occurred in 25% of the sessions. Independent risk factors (RF) for hypotension were dialysate conductivity (each ms/cm, OR 0.81, CI 0.69-0.95), initial mean arterial pressure (each 10 mmHg, OR 0.49, CI 0.40-0.61) and SOFA score (OR 1.16, CI 1.03-1.30). Clotting and malfunctioning catheters (MC) occurred in 23.8% and 29.2% of the procedures, respectively. Independent RF for clotting were heparin use (OR 0.57, CI 0.33-0.99), MC (OR 3.59, CI 2.24-5.77) and RRT system pressure increase over 25% (OR 2.15, CI 1.61-4.17). Post RRT blood tests were urea 71 (49-104) mg/dL, creatinine 2.71 (2.10-3.8) mg/dL, bicarbonate 24.1 (22.5-25.5) mEq/L and K 3.8 (3.5-4.1) mEq/L.
CONCLUSION
IHD for critically ill patients with cancer and AKI offered acceptable hemodynamic stability and provided adequate metabolic control.
背景
关于重症监护病房（ICU）中急性肾损伤（AKI）癌症患者的肾脏替代治疗（RRT）的数据稀缺。本研究的目的是评估间歇性血液透析（IHD）在重症AKI癌症患者中的安全性和充分性。
方法与结果
在这项观察性前瞻性队列研究中，对149例ICU中患有AKI的癌症患者进行了448次单通道批量IHD治疗，并于2010年6月至2012年6月进行了评估。主要结局是IHD并发症（低血压和凝血）及充分性。进行了多元逻辑回归以确定与IHD并发症（低血压和凝血）相关的因素。患者年龄为62.2±14.3岁，86.6%患有实体癌，脓毒症是主要的AKI病因（51%），住院死亡率为59.7%。RRT治疗时间为240（180 - 300）分钟，血液/透析液流速为250（200 - 300）毫升/分钟，超滤量为1000（0 - 2000）毫升。25%的治疗过程中出现低血压。低血压的独立危险因素（RF）为透析液电导率（每毫西门子/厘米，比值比[OR]0.81，可信区间[CI]0.69 - 0.95）、初始平均动脉压（每10毫米汞柱，OR 0.49，CI 0.40 - 0.61）和序贯器官衰竭评估（SOFA）评分（OR 1.16，CI 1.03 - 1.30）。凝血和导管故障（MC）分别发生在23.8%和29.2%的治疗过程中。凝血的独立RF为肝素使用（OR 0.57，CI 0.33 - 0.99）、MC（OR 3.59，CI 2.24 - 5.77）和RRT系统压力升高超过25%（OR 2.15，CI 1.61 - 4.17）。RRT后血液检测结果为尿素71（49 - 104）毫克/分升、肌酐2.71（2.10 - 3.8）毫克/分升、碳酸氢盐24.1（22.5 - 25.5）毫当量/升和钾3.8（3.5 - 4.1）毫当量/升。
结论
对重症癌症合并AKI患者进行IHD可提供可接受的血流动力学稳定性并实现充分的代谢控制。
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