Kao Chih-Chin, Yang Ju-Yeh, Chen Likwang, Chao Chia-Ter, Peng Yu-Sen, Chiang Chih-Kang, Huang Jenq-Wen, Hung Kuan-Yu
Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
PLoS One. 2017 May 24;12(5):e0177759. doi: 10.1371/journal.pone.0177759. eCollection 2017.
Continuous renal replacement therapy (CRRT) is one of the dialysis modalities for critically ill patients. Despite intensive dialysis care, a high mortality rate is found in these patients. Our objective was to investigate the factors associated with poor outcomes in these patients. We conducted a retrospective cohort study using the National Health Insurance Research Database. Records of critically ill patients who received CRRT between 2007 and 2011 were retrieved, and the patients were categorized into two groups: those with acute kidney injury (AKI) and those with history of end-stage renal disease (ESRD). Our primary and secondary outcomes were in-hospital mortality and long-term survival and non-renal recovery (long-term dialysis dependence), respectively, in the AKI group. We enrolled 15,453 patients, with 13,204 and 2249 in the AKI and ESRD groups, respectively. Overall, 66.5% patients died during hospitalization. In-hospital mortality did not differ significantly between groups (adjusted odds ratio, 0.93; 95% CI, 0.84-1.02). Age, chronic liver disease, and cancer history were identified as independent risk factors for in-hospital mortality in both groups. Hypertension was associated with higher risk of in-hospital mortality in patients with AKI. Age, coronary artery disease, and admission to the medical intensive care unit (MICU) were risk factors for long-term dialysis dependence in patients with AKI. Patients with AKI and ESRD have similarly poor outcomes after CRRT. Older age and presence of chronic liver disease and cancer were associated with higher mortality. Older age, presence of coronary artery disease, and admission to MICU were associated with lower renal recovery rate in patients with AKI.
连续性肾脏替代治疗（CRRT）是危重症患者的透析方式之一。尽管进行了强化透析治疗，但这些患者的死亡率仍然很高。我们的目的是调查与这些患者不良预后相关的因素。我们使用国民健康保险研究数据库进行了一项回顾性队列研究。检索了2007年至2011年间接受CRRT的危重症患者记录，并将患者分为两组：急性肾损伤（AKI）患者和终末期肾病（ESRD）病史患者。我们的主要和次要结局分别是AKI组的住院死亡率、长期生存率和非肾脏恢复情况（长期透析依赖）。我们纳入了15453例患者，其中AKI组13204例，ESRD组2249例。总体而言，66.5%的患者在住院期间死亡。两组间住院死亡率无显著差异（调整优势比，0.93；95%CI，0.84 - 1.02）。年龄、慢性肝病和癌症病史被确定为两组住院死亡率的独立危险因素。高血压与AKI患者更高的住院死亡风险相关。年龄、冠状动脉疾病和入住医学重症监护病房（MICU）是AKI患者长期透析依赖的危险因素。AKI和ESRD患者在接受CRRT后的预后同样较差。高龄、存在慢性肝病和癌症与更高的死亡率相关。高龄、存在冠状动脉疾病和入住MICU与AKI患者较低的肾脏恢复率相关。
