Shum Hoi-Ping, Chan King-Chung, Tam Catherine W-Y, Yan Wing-Wa, Chan Tak-Mao
Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
Department of Anesthesia and Intensive Care, TuenMun Hospital, Hong Kong, China.
Nephrology (Carlton). 2018 Dec;23(12):1081-1089. doi: 10.1111/nep.13164.
To investigate the impact of renal replacement therapy (RRT) on 90-day mortality in critically ill patients suffering from KDIGO stage 3 acute kidney injury (AKI) with or without life-threatening complications using propensity score matching analysis.
We conducted a retrospective analysis of critically ill adult patients with KDIGO Stage 3 AKI with or without RRT during ICU stay between 1/1/2011-31/12/2013. Cox regression analysis and propensity score matching methods were used to determine predictors for 90-day mortality.
Among 661 patients, 50.5% received RRT. The unadjusted 90-day mortality rate was 42.5% and 54.1% in patients who had or had not received RRT, respectively. After adjustment with propensity score based on the probability of receiving RRT, the cox regression analysis showed that RRT was associated with a lower 90-day mortality (p<0.001). Among 322 propensity-matched pairs, RRT was associated with lower ICU (23.6% vs. 39.8%, p=0.002), hospital (33.5% vs. 55.9%, p<0.001) and 90-day mortality (34.2% vs. 58.4%, p<0.001), and a higher 90-day renal recovery rate (57.8% vs. 45.3% full recovery, p=0.026) compared with no RRT. When an alternate propensity model was used, the benefits associated with RRT were very similar, except 90-day renal recovery became insignificant.
Our observational study found that in critically ill patients with KDIGO Stage 3 AKI, RRT may be associated with lower 90-day mortality. The benefit of RRT on renal recovery was less prominent. Medical futility and practice variations may complicate study interpretation. To avoid these limitations, large-scale multicenter, non-observational study is recommended.
采用倾向评分匹配分析，研究肾脏替代治疗（RRT）对患有KDIGO 3期急性肾损伤（AKI）且伴有或不伴有危及生命并发症的危重症患者90天死亡率的影响。
我们对2011年1月1日至2013年12月31日期间在重症监护病房（ICU）住院的患有KDIGO 3期AKI且接受或未接受RRT的成年危重症患者进行了回顾性分析。采用Cox回归分析和倾向评分匹配方法确定90天死亡率的预测因素。
661例患者中，50.5%接受了RRT。接受或未接受RRT的患者未调整的90天死亡率分别为42.5%和54.1%。基于接受RRT的概率进行倾向评分调整后，Cox回归分析显示RRT与较低的90天死亡率相关（p<0.001）。在322对倾向评分匹配的病例中，与未接受RRT相比，RRT与较低的ICU死亡率（23.6%对39.8%，p=0.002）、医院死亡率（33.5%对55.9%，p<0.001）和90天死亡率（34.2%对58.4%，p<0.001）相关，且90天肾脏恢复率更高（完全恢复率为57.8%对45.3%，p=0.026）。当使用替代倾向模型时，与RRT相关的益处非常相似，只是90天肾脏恢复变得不显著。
我们的观察性研究发现，在患有KDIGO 3期AKI的危重症患者中，RRT可能与较低的90天死亡率相关。RRT对肾脏恢复的益处不太显著。医疗无效性和实践差异可能使研究解释复杂化。为避免这些局限性，建议进行大规模多中心非观察性研究。
