Ávalos-López Mariana, Pérez-López María Juana, Aguilar-Martínez Carolina, Díaz-Franco Ana María del Carmen, Esquivel-Chávez Alejandro, Baltazar-Torres José Angel
Hospital de Especialidades "Dr. Antonio Fraga Mouret", Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
Rev Med Inst Mex Seguro Soc. 2017 Nov-Dec;55(6):696-703.
Acute kidney injury (AKI) is common in critically ill patients and it is associated with poor outcome. Some patients require renal replacement therapy (RRT), and the most frequently used are intermittent hemodialysis (IHD) and continuous renal replacement therapies (CRRT). Current evidence is insufficient to conclude which modality is most appropriate to treat critically ill patients with AKI.
We reviewed the clinical records of critically ill patients with stage 3 AKI treated with RRT. We recorded demographic and clinical data and serum creatinine. We compared the evolution and prognosis of patients treated with IHD versus those treated with CRRT by Student's t test, chi squared, Kaplan-Meier curves, and Cox regression. Logistic regression was performed to determine the association between RRT and mortality.
We analyzed 221 patients; the mean age was 49.8 years, and 55.2% were men. Mortality was 36.7%. IHD was used in 73.8% and CRRT in 26.2% of cases. In the group treated with CRRT, the severity of disease was higher, the recovery of renal function less frequent, the need for long-term RRT less frequent, and mortality higher, compared with those treated with IHD. CRRTs had an odds ratio (OR) of 8.64 for mortality (p = 0.063).
IHD is the RRT most frequently used. Mortality is higher in patients treated with CRRT. CRRTs are not an independent risk factor for death.
急性肾损伤（AKI）在重症患者中很常见，且与不良预后相关。一些患者需要肾脏替代治疗（RRT），最常用的是间歇性血液透析（IHD）和连续性肾脏替代治疗（CRRT）。目前的证据不足以得出哪种治疗方式最适合治疗重症AKI患者的结论。
我们回顾了接受RRT治疗的重症3期AKI患者的临床记录。我们记录了人口统计学和临床数据以及血清肌酐。我们通过学生t检验、卡方检验、Kaplan-Meier曲线和Cox回归比较了接受IHD治疗的患者与接受CRRT治疗的患者的病情演变和预后。进行逻辑回归以确定RRT与死亡率之间的关联。
我们分析了221例患者；平均年龄为49.8岁，55.2%为男性。死亡率为36.7%。73.8%的病例使用IHD，26.2%的病例使用CRRT。与接受IHD治疗的患者相比，接受CRRT治疗的患者疾病严重程度更高，肾功能恢复频率更低，长期RRT需求频率更低，死亡率更高。CRRT的死亡比值比（OR）为8.64（p = 0.063）。
IHD是最常用的RRT。接受CRRT治疗的患者死亡率更高。CRRT不是死亡的独立危险因素。
