Kara Iskender, Yildirim Fatma, Kayacan Esra, Bilaloğlu Burcu, Turkoglu Melda, Aygencel Gülbin
Department of Anesthesiology and Reanimation, Gazi University Faculty of Medicine, Intensive Care Training Program, Anlara, Turkey.
Department of Pulmonology, Intensive Care Training Program, Gazi University Faculty of Medicine, Anlara, Turkey.
Iran J Med Sci. 2017 Jul;42(4):397-403.
Our study evaluated the differences between early and late hemodialysis (HD) initiation in the intensive care unit (ICU) according to the RIFLE (Risk, Injury, Failure, Loss, and End-stage renal failure) and AKIN (Acute Kidney Injury Network) classifications. On the assumption that early initiation of HD in critical patients according to the RIFLE and AKIN criteria decreases mortality, we retrospectively evaluated the medical records of 68 patients in our medical ICU and divided the patients into 2 groups: Those undergoing HD in no risk, risk, or injury stage according to RIFLE and in stage 0, I, or II according to AKIN were defined as early HD and those in failure stage according to RIFLE and in stage III according to AKIN were defined as late HD. The median age of the patients was 66.5 years, and 56.5% were male. HD was started in 25% and 39.7% of the patients in the early stage in the RIFLE and AKIN classification, respectively. According to RIFLE, HD was started in 61.5% of the surviving patients in the early stage; this rate was 16.4% in the deceased patients (P=0.001). HD was commenced in 69.2% of the surviving patients in AKIN stages 0, I, and II and in 32.7% of the deceased patients (P=0.026). Sepsis (61.5% vs. 94.5%; P=0.001) and mechanical ventilation (30.8% vs. 87.3%; P<0.001) during HD increased ICU mortality, whereas HD initiation in the early stages according to RIFLE decreased ICU mortality (61.5% vs. 16.4%; P=0.001). In conclusion, in critically ill patients, HD initiation in the early stages according to the RIFLE classification decreased our ICU mortality.
我们的研究根据RIFLE（风险、损伤、衰竭、丧失和终末期肾衰竭）和AKIN（急性肾损伤网络）分类评估了重症监护病房（ICU）中早期和晚期血液透析（HD）起始的差异。基于根据RIFLE和AKIN标准在危重症患者中早期开始HD可降低死亡率这一假设，我们回顾性评估了我们医疗ICU中68例患者的病历，并将患者分为两组：根据RIFLE处于无风险、风险或损伤阶段且根据AKIN处于0期、I期或II期接受HD的患者被定义为早期HD，而根据RIFLE处于衰竭阶段且根据AKIN处于III期的患者被定义为晚期HD。患者的中位年龄为66.5岁，56.5%为男性。在RIFLE和AKIN分类中，分别有25%和39.7%的患者在早期开始HD。根据RIFLE，61.5%的存活患者在早期开始HD；在死亡患者中这一比例为16.4%（P = 0.001）。在AKIN 0期、I期和II期的存活患者中，69.2%开始了HD，而在死亡患者中这一比例为32.7%（P = 0.026）。HD期间的脓毒症（61.5%对94.5%；P = 0.001）和机械通气（38%对87.3%；P < 0.001）会增加ICU死亡率，而根据RIFLE在早期开始HD可降低ICU死亡率（61.5%对16.4%；P = 0.001）。总之，在危重症患者中，根据RIFLE分类在早期开始HD可降低我们ICU的死亡率。
