Riley Alyssa A, Watson Mary, Smith Carolyn, Guffey Danielle, Minard Charles G, Currier Helen, Akcan Arikan Ayse
Department of Pediatrics, Renal Section, Baylor College of Medicine, Houston, TX, USA.
Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
BMC Nephrol. 2018 Oct 19;19(1):268. doi: 10.1186/s12882-018-1068-1.
To evaluate changes in population characteristics and outcomes in a large single-center pediatric patient cohort treated with continuous renal replacement therapy (CRRT) over a 10 year course, coincident with multiple institutional practice changes in CRRT delivery.
A retrospective cohort study with comparative analysis of all patients treated from 2004 to 2013 with CRRT in the neonatal, pediatric, and cardiovascular intensive care units within a free-standing pediatric tertiary care hospital.
Three hundred eleven total patients were identified, 38 of whom received concurrent treatment with extracorporeal membrane oxygenation. 273 patients received CRRT only and were compared in two study eras (2004-2008 n = 129; 2009-2013 n = 144). Across eras, mean patient age decreased (9.2 vs 7.7 years, p = 0.08), and the most common principal diagnosis changed from cardiac to liver disease. There was an increase in patients treated with continuous renal replacement therapy between cohorts for acute kidney injury of multi factorial etiology (44% vs 56%) and a decrease in treated patients with sepsis (21% vs 11%, p = 0.04). There was no significant difference in survival to hospital discharge between eras (47% vs 49%). Improvement in outpatient follow-up after discharge amongst survivors was seen between study eras (33% vs 54%).
Despite multiple institutional practice changes in provision of CRRT, few changes were seen regarding patient demographics, diseases treated, indications for therapy, and survival over 10 years at a single tertiary care. Recognition of need for follow-up nephrology care following CRRT is improving. Ongoing assessment of the patient population in a changing landscape of care for critically ill pediatric patients remains important.
为评估在10年期间接受持续肾脏替代疗法（CRRT）治疗的大型单中心儿科患者队列中的人群特征和结局变化，这一时期同时发生了CRRT实施方面的多项机构实践变化。
一项回顾性队列研究，对一家独立的儿科三级护理医院的新生儿、儿科和心血管重症监护病房中2004年至2013年接受CRRT治疗的所有患者进行比较分析。
共识别出311例患者，其中38例同时接受体外膜肺氧合治疗。273例患者仅接受CRRT治疗，并在两个研究时期进行比较（2004 - 2008年n = 129；2009 - 2013年n = 144）。跨时期来看，患者平均年龄下降（9.2岁对7.7岁，p = 0.08），最常见的主要诊断从心脏疾病变为肝脏疾病。多因素病因导致的急性肾损伤患者队列中接受持续肾脏替代疗法治疗的比例增加（44%对56%），脓毒症治疗患者比例下降（21%对11%，p = 0.04）。不同时期出院生存率无显著差异（47%对49%）。研究时期之间，幸存者出院后门诊随访情况有所改善（33%对54%）。
尽管在CRRT的提供方面有多项机构实践变化，但在单一三级护理机构中，10年间患者人口统计学特征、治疗疾病、治疗指征和生存率方面几乎没有变化。对CRRT后随访肾病护理需求的认识正在提高。在危重症儿科患者护理不断变化的背景下，持续评估患者群体仍然很重要。
