Paek Jin Hyuk, Park Seohyun, Lee Anna, Park Seokwoo, Chin Ho Jun, Na Ki Young, Lee Hajeong, Park Jung Tak, Kim Sejoong
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Kidney Res Clin Pract. 2018 Sep;37(3):239-247. doi: 10.23876/j.krcp.2018.37.3.239. Epub 2018 Sep 30.
Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy used in critically ill patients with severe cardiopulmonary dysfunction. Continuous renal replacement therapy (CRRT) is supplemented to treat fluid overload, acute kidney injury, and electrolyte disturbances during ECMO. However, the best time to initiate CRRT is not well-defined. We performed this study to identify the optimal timing of CRRT for ECMO.
We conducted a multicenter retrospective cohort study of 296 patients over 12 years. Patients received CRRT during ECMO at Seoul National University Hospital, Seoul National University Bundang Hospital, or Yonsei University Hospital. We assigned patients to an early or late CRRT group depending on the CRRT initiation time. We considered early CRRT to be CRRT instituted within 72 hours of ECMO initiation.
Among 296 patients, 212 patients (71.6%) received early CRRT. After using a propensity score matching method, 47 patients were included in each group. The time from ECMO initiation to CRRT initiation was 1.1 ± 0.9 days in the early CRRT group and 14.6 ± 18.6 days in the late CRRT group. No difference in patients' mortality ( = 0.834) or hospital stay ( = 0.627) between the early and late CRRT groups was found. After adjusting all covariables, there was no significant difference in mortality between the early and late CRRT groups (hazard ratio, 0.697; 95% confidence interval, 0.410-1.184; = 0.182).
This study showed that early CRRT may not be superior to late CRRT in ECMO patients. Further clinical trials are warranted.
体外膜肺氧合（ECMO）是用于治疗严重心肺功能障碍危重症患者的一种挽救生命的疗法。在ECMO治疗期间，需补充连续性肾脏替代疗法（CRRT）以治疗液体超负荷、急性肾损伤及电解质紊乱。然而，启动CRRT的最佳时机尚未明确界定。我们开展本研究以确定ECMO患者CRRT的最佳时机。
我们进行了一项为期12年的多中心回顾性队列研究，纳入296例患者。这些患者在首尔国立大学医院、首尔国立大学盆唐医院或延世大学医院接受ECMO期间接受了CRRT治疗。根据CRRT启动时间，我们将患者分为早期CRRT组或晚期CRRT组。我们将早期CRRT定义为在ECMO启动后72小时内开始的CRRT。
296例患者中，212例（71.6%）接受了早期CRRT。采用倾向评分匹配法后，每组纳入47例患者。早期CRRT组从ECMO启动到CRRT启动的时间为1.1±0.9天，晚期CRRT组为14.6±18.6天。早期和晚期CRRT组患者的死亡率（P=0.834）或住院时间（P=0.627）无差异。调整所有协变量后，早期和晚期CRRT组的死亡率无显著差异（风险比，0.697；95%置信区间，0.410 - 1.184；P=0.182）。
本研究表明，在接受ECMO治疗的患者中，早期CRRT可能并不优于晚期CRRT。有必要开展进一步的临床试验。
