Rhee Harin, Jang Gum Sook, An Yeo Jin, Han Miyeun, Park Inseong, Kim Il Young, Seong Eun Young, Lee Dong Won, Lee Soo Bong, Kwak Ihm Soo, Song Sang Heon
Department of Internal Medicine, Pusan National University School of Medicine, Pusan, Republic of Korea.
Division of Nephrology, Biomedical Research Institute, Pusan National University Hospital, Gudeok-ro179, Seo-gu, Pusan, 602-739, Republic of Korea.
Clin Exp Nephrol. 2018 Dec;22(6):1411-1419. doi: 10.1007/s10157-018-1595-x. Epub 2018 Jun 11.
Acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) is the most severe form of AKI associated with poor short- and long-term patient outcomes. The aim of this study was to evaluate the variables associated with long-term patient survival in our clinic.
This was a single-center retrospective study with AKI survivors who received CRRT from March 2011 to February 2015. During the study period, all consecutive AKI survivors who underwent CRRT were included. Patients on maintenance dialysis prior to CRRT were excluded. Data were collected by reviewing the patients' medical charts. Long-term follow-up data were gathered through February 2018.
A total of 430 patients were included, and 62.8% of the patients were male. The mean age of the patients was 63.4 ± 14.6 years. The mean serum creatinine level at the time of CRRT initiation was 3.5 ± 2.5 mg/dL. At the time of discharge, the mean eGFR and serum creatinine levels were 58.4 ± 46.7 and 1.7 ± 1.6 mg/dL, respectively. After 3 years, 44.9% of the patients had survived. When we investigated the factors associated with long-term patient mortality, a longer stay in the ICU [OR 1.034 (1.016-1.053), p < 0.001], a history of cancer [OR 3.830 (1.037-3.308), p = 0.037], a prolonged prothrombin time [OR 1.852 (1.037-3.308), p = 0.037] and a lower eGFR at the time of discharge [OR 0.988 (0.982-0.995), p = 0.001] were independently associated with long-term patient mortality.
Our study demonstrates that long-term mortality after CRRT is associated with longer ICU stays and lower eGFRs at the time of hospital discharge. Our data imply the importance of renal recovery for long-term survival of AKI patients treated with CRRT.
需要持续肾脏替代治疗（CRRT）的急性肾损伤（AKI）是与患者短期和长期不良预后相关的最严重的AKI形式。本研究的目的是评估与我们诊所患者长期生存相关的变量。
这是一项单中心回顾性研究，研究对象为2011年3月至2015年2月接受CRRT治疗的AKI幸存者。在研究期间，纳入了所有接受CRRT治疗的连续性AKI幸存者。排除CRRT治疗前已接受维持性透析的患者。通过查阅患者病历收集数据。长期随访数据收集至2018年2月。
共纳入430例患者，其中62.8%为男性。患者的平均年龄为63.4±14.6岁。开始CRRT治疗时的平均血清肌酐水平为3.5±2.5mg/dL。出院时，平均估算肾小球滤过率（eGFR）和血清肌酐水平分别为58.4±46.7和1.7±1.6mg/dL。3年后，44.9%的患者存活。当我们调查与患者长期死亡率相关的因素时，在重症监护病房（ICU）停留时间较长[比值比（OR）1.034（1.016 - 1.053），p<0.001]、有癌症病史[OR 3.830（1.037 - 3.308），p = 0.037]、凝血酶原时间延长[OR 1.852（1.037 - 3.308），p = 0.037]以及出院时较低的eGFR[OR 0.988（0.982 - 0.995），p = 0.001]与患者长期死亡率独立相关。
我们的研究表明，CRRT治疗后的长期死亡率与在ICU停留时间较长以及出院时较低的eGFR相关。我们的数据表明肾脏恢复对接受CRRT治疗的AKI患者长期生存的重要性。
