Mishra Shakti Bedanta, Azim Afzal, Prasad Narayan, Singh Ratendra Kumar, Poddar Banani, Gurjar Mohan, Baronia Arvind Kumar
Department of Critical Care Medicine, IMS and SUM Hospital, Bhubaneswar, Odisha, India.
Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Indian J Crit Care Med. 2017 May;21(5):262-267. doi: 10.4103/ijccm.IJCCM_85_17.
Acute kidney injury (AKI) is common in patients of septic shock. There is sparse data comparing sustained low-efficiency dialysis (SLED) and continuous renal replacement therapy (CRRT) in patients with septic shock.
This is a prospective randomized study in a 12-bedded medical intensive care unit. After clearance from institute's ethics committee and obtaining informed consent from the relatives, sixty adult patients with septic shock who were to undergo dialysis for AKI were included in the study. They were randomly assigned to SLED or CRRT group. Hemodynamic instability was defined as in terms of vasopressor dependency (VD). The worst value of VD during the dialysis session was taken into consideration. The primary objective was look at hemodynamic changes and secondarily into the efficacy.
The demographic data were comparable between the sixty patients randomized to thirty in each group. Delta VD and delta vasopressor index (DVI) were similar in SLED group compared to the CRRT group. CRRT group had better efficacy in terms of both equivalent renal urea clearance though fluid balance was not significantly better in CRRT group.
SLED is a viable modality of renal replacement therapy in patients with septic shock as the hemodynamic effects are similar to CRRT.
急性肾损伤（AKI）在感染性休克患者中很常见。关于感染性休克患者持续性低效透析（SLED）和连续性肾脏替代治疗（CRRT）的比较数据很少。
这是一项在拥有12张床位的医学重症监护病房进行的前瞻性随机研究。在获得机构伦理委员会批准并取得亲属的知情同意后，60例因AKI需接受透析的成年感染性休克患者被纳入研究。他们被随机分配到SLED组或CRRT组。血流动力学不稳定定义为对血管升压药的依赖（VD）。考虑透析期间VD的最差值。主要目标是观察血流动力学变化，其次是观察疗效。
随机分为两组，每组30例的60例患者的人口统计学数据具有可比性。与CRRT组相比，SLED组的VD变化量（Delta VD）和血管升压药指数变化量（DVI）相似。尽管CRRT组的液体平衡改善不显著，但在等效肾脏尿素清除率方面，CRRT组的疗效更好。
SLED是感染性休克患者可行的肾脏替代治疗方式，因为其血流动力学效应与CRRT相似。
