Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan.
Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
Clin Exp Nephrol. 2019 Jun;23(6):814-824. doi: 10.1007/s10157-019-01711-y. Epub 2019 Feb 16.
Although recovery of renal function after an episode of acute kidney injury (AKI) is an important clinical measure of morbidity, predictors of withdrawal from renal replacement therapy (RRT) among AKI patients remain unclear.
In this single-center retrospective cohort study, we examined the clinical records of AKI patients requiring RRT who were hospitalized in the ICU or general wards at our hospital from January 2010 to December 2013. A priori-determined covariates of age, sex, cardiovascular disease, chronic kidney disease (CKD), mean arterial pressure (MAP), sepsis, nephrotoxic agents, and hypoalbuminemia were assessed in Cox hazard models to estimate hazard ratio (HR).
A total of 334 patients were enrolled (median age, 68 years; interquartile range [IQR], 57-77 years; male, 71.6%). During follow-up 157 (47.0%) patients achieved RRT withdrawal. Multivariable Cox regression analysis revealed that CKD, MAP between 95 and 105 mmHg and MAP ≥ 105 mmHg, compared with MAP between 65 and 75 mmHg, ventilator use and hypoalbuminemia, were significantly associated with RRT withdrawal.
Among patients with AKI requiring RRT, CKD, ventilator use, hypoalbuminemia, and high MAP were associated with RRT withdrawal. Furthermore, keeping a higher MAP at RRT initiation can potentially lead to dependence on RRT.
尽管急性肾损伤（AKI）发作后肾功能的恢复是发病率的一个重要临床指标，但 AKI 患者停止肾脏替代治疗（RRT）的预测因素仍不清楚。
在这项单中心回顾性队列研究中，我们检查了 2010 年 1 月至 2013 年 12 月期间在我院 ICU 或普通病房住院需要 RRT 的 AKI 患者的临床记录。在 Cox 危险模型中评估了预先确定的协变量（年龄、性别、心血管疾病、慢性肾脏病（CKD）、平均动脉压（MAP）、脓毒症、肾毒性药物和低白蛋白血症），以估计危险比（HR）。
共纳入 334 例患者（中位年龄 68 岁；四分位距 [IQR]，57-77 岁；男性 71.6%）。在随访期间，157 例（47.0%）患者实现了 RRT 撤机。多变量 Cox 回归分析显示，CKD、95-105mmHg 和 MAP≥105mmHg 与 65-75mmHg 之间的 MAP 相比，呼吸机使用和低白蛋白血症与 RRT 撤机显著相关。
在需要 RRT 的 AKI 患者中，CKD、呼吸机使用、低白蛋白血症和高 MAP 与 RRT 撤机相关。此外，在开始 RRT 时保持较高的 MAP 可能会导致对 RRT 的依赖。
