一项中国横断面研究中急性肾损伤的肾脏替代治疗：治疗的患者、临床、社会经济和卫生服务预测因素
Renal replacement therapy in acute kidney injury from a Chinese cross-sectional study: patient, clinical, socioeconomic and health service predictors of treatment.
作者信息
Wang Fang, Hong Daqing, Wang Yafang, Feng Yunlin, Wang Li, Yang Li
机构信息
Division of Nephrology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China.
Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034, People's Republic of China.
出版信息
BMC Nephrol. 2017 May 4;18(1):152. doi: 10.1186/s12882-017-0567-9.
BACKGROUND
Renal replacement therapy (RRT) is important to support critically ill patients with acute kidney injury (AKI). This study, a part of a nation-wide survey for AKI conducted by the ISN AKF 0 by 25 China Consortium, aims to study the current RRT practical situation and problems in China.
METHODS
The current study is a part of a nation-wide survey for AKI conducted by ISN AKF 0 by 25 China Consortium. The survey included 44 sites all over the country, including 22 academic hospitals in big cities and 22 local hospitals in smaller cities or rural areas. Of the 44 sites, all have access to PD and IHD, 93.5% are capable to perform CRRT. Of total 7604 AKI cases, 896 cases (11.8%) had indications for RRT and were included in the current abstract.
RESULTS
of the 896 patients that had indications for RRT, only 59.3% received RRT. Patients who were older, male, from lower income areas, in local hospitals, or with severe comorbidities, were less likely to receive RRT. RRT treatment was associated with lower mortality (OR = 0.58, 95%CI 0.38-0.89). The RRT modalities were continuous renal replacement therapy (CRRT) in 53.9%, intermittent hemodialysis (IHD) in 38.0%, CRRT complemented by IHD in 6.2%, CRRT complemented by peritoneal dialysis (PD) in 0.8% and PD in 1.1%. Of the subgroup of patients receiving RRT who did not have an indication for modality of CRRT, 36.8% in fact received CRRT, and their medical cost and mortality rate was higher (7944[4248, 16,055] vs. 5100[2948, 9396] US dollars, p < 0.001 and 10.6% vs. 4.4%, p = 0.047, respectively) compared with those treated with other RRT modalities).
CONCLUSIONS
Extrapolated to the whole of China our results indicate that an estimated 139,000 patients with an indication of RRT are under treated without RRT over a year. Non-clinical factors influence RRT prescription for severe AKI patients. CRRT may be over-utilized in the treatment of severe AKI and the use of PD is extremely rare. These findings have implications for the effective application of medical resources in the treatment of severe AKI.
背景
肾脏替代治疗（RRT）对于支持急性肾损伤（AKI）的危重症患者至关重要。本研究是国际肾脏病学会急性肾损伤中国协作组开展的全国性AKI调查的一部分，旨在研究中国目前RRT的实际应用情况及问题。
方法
本研究是国际肾脏病学会急性肾损伤中国协作组开展的全国性AKI调查的一部分。该调查涵盖全国44个地点，包括22家大城市的学术医院和22家小城市或农村地区的当地医院。在这44个地点中，所有地点都可开展腹膜透析（PD）和间歇性血液透析（IHD），93.5%的地点能够进行连续性肾脏替代治疗（CRRT）。在总共7604例AKI病例中，896例（11.8%）有RRT指征并被纳入本摘要。
结果
在896例有RRT指征的患者中，仅59.3%接受了RRT。年龄较大、男性、来自低收入地区、在当地医院就诊或有严重合并症的患者接受RRT的可能性较小。RRT治疗与较低的死亡率相关（OR = 0.58，95%CI 0.38 - 0.89）。RRT模式为连续性肾脏替代治疗（CRRT）占53.9%，间歇性血液透析（IHD）占38.0%，CRRT联合IHD占6.2%，CRRT联合腹膜透析（PD）占0.8%，PD占1.1%。在接受RRT但无CRRT模式指征的患者亚组中，36.8%实际上接受了CRRT，与接受其他RRT模式治疗的患者相比，他们的医疗费用和死亡率更高（分别为7944[4248, 16055]美元对5100[2948, 9396]美元，p < 0.001；10.6%对4.4%，p = 0.047）。
结论
extrapolated to the whole of China our results indicate that an estimated 139,000 patients with an indication of RRT are under treated without RRT over a year. Non-clinical factors influence RRT prescription for severe AKI patients. CRRT may be over-utilized in the treatment of severe AKI and the use of PD is extremely rare. These findings have implications for the effective application of medical resources in the treatment of severe AKI.（原文最后一句英文表述有误，推测正确内容为：推广至中国全国范围，我们的结果表明，估计每年有139,000例有RRT指征的患者未接受RRT治疗。非临床因素影响重症AKI患者的RRT处方。CRRT在重症AKI治疗中可能存在过度使用的情况，而PD的使用极为罕见。这些发现对重症AKI治疗中医疗资源的有效应用具有启示意义。） （最后一句英文表述推测为错误录入，因此按照推测纠正后翻译，你可根据实际情况进行调整）
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