Viallet Nicolas, Brunot Vincent, Kuster Nils, Daubin Delphine, Besnard Noémie, Platon Laura, Buzançais Aurèle, Larcher Romaric, Jonquet Olivier, Klouche Kada
Department of Intensive Care Medicine, Lapeyronie University Hospital, 371, Avenue du Doyen G. Giraud, 34295, Montpellier, France.
Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France.
Ann Intensive Care. 2016 Dec;6(1):71. doi: 10.1186/s13613-016-0176-y. Epub 2016 Jul 22.
In acute kidney injury (AKI), useless continuation of renal replacement therapy (RRT) may delay renal recovery and impair patient's outcome. In this study, we aimed to identify predictive parameters that may help to a successful RRT weaning for AKI patients.
We studied 54 surviving AKI patients in which a weaning of RRT was attempted. On the day of weaning (D0) and the following 2 days (D1 and D2), SAPS II and SOFA scores, 24-h diuresis, 24-h urinary creatinine and urea (UCr and UUr), creatinine and urea generation rates (CrGR and UrGR) and clearances (CrCl and UrCl) were collected. Patients who remained free of RRT 15 days after its discontinuation were considered as successfully weaned.
Twenty-six RRT weaning attempts succeeded (S+) and 28 failed (S-). Age, previous renal function, SAPS II and SOFA scores were comparable between groups. At D0, 24-h diuresis was 2300 versus 1950 ml in S+ and S-, respectively, p = 0.05. At D0, D1 and D2, 24-h UUr and UCr levels, UrCl and CrCl, and UUr/UrGR and UCr/CrGR ratios were significantly higher in S+ group. By multivariate analysis, D1 24-h UCr was the most powerful parameter that was associated with RRT weaning success with an area under the ROC curve of 0.86 [0.75-0.97] and an odds ratio of 2.01 [1.27-3.18], p = 0.003.
In ICU AKI, 24-h UCr appeared as an efficient and independent marker of a successful weaning of RRT. A 24-h UCr ≥5.2 mmol was associated with a successful weaning in 84 % of patients.
在急性肾损伤（AKI）中，无效地持续进行肾脏替代治疗（RRT）可能会延迟肾脏恢复并损害患者的预后。在本研究中，我们旨在确定有助于AKI患者成功撤机的预测参数。
我们研究了54例存活的AKI患者，这些患者尝试进行RRT撤机。在撤机当天（D0）及随后的2天（D1和D2），收集急性生理与慢性健康状况评分系统II（SAPS II）和序贯器官衰竭评估（SOFA）评分、24小时尿量、24小时尿肌酐和尿素（UCr和UUr）、肌酐和尿素生成率（CrGR和UrGR）以及清除率（CrCl和UrCl）。在停止RRT 15天后仍未进行RRT的患者被视为成功撤机。
26次RRT撤机尝试成功（S+），28次失败（S-）。两组患者的年龄、既往肾功能、SAPS II和SOFA评分相当。在D0时，S+组和S-组的24小时尿量分别为2300 ml和1950 ml，p = 0.05。在D0、D1和D2时，S+组的24小时UUr和UCr水平、UrCl和CrCl以及UUr/UrGR和UCr/CrGR比值均显著更高。通过多变量分析，D1时的24小时UCr是与RRT撤机成功相关的最有力参数，ROC曲线下面积为0.86 [0.75 - 0.97]，比值比为2.01 [1.27 - 3.18]，p = 0.003。
在重症监护病房（ICU）的AKI患者中，24小时UCr似乎是RRT成功撤机的有效且独立的标志物。24小时UCr≥5.2 mmol与84%的患者成功撤机相关。
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