Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA,
Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Am J Nephrol. 2020;51(4):318-326. doi: 10.1159/000506412. Epub 2020 Feb 25.
Continuous renal replacement therapy (CRRT) is commonly employed in the intensive care unit (ICU), though there are no guidelines around the transition between CRRT and intermittent hemodialysis (iHD). Accelerated venovenous hemofiltration (AVVH) is a modality utilizing higher hemofiltration rates (4-5 L/h) with shorter session durations (8-10 h) to "accelerate" the clearance and volume removal that normally is spread out over a 24-h period in CRRT. We examined AVVH as a transition therapy between CRRT and iHD, with the aim of decreasing time on CRRT and providing a more graduated transition for hemodynamically unstable patients requiring RRT.
Retrospective cohort study describing the clinical outcomes and quality initiative experience of the integration of AVVH into the CRRT program at an academic tertiary care center. Outcomes of interest included mortality, ICU length of stay and readmission rates, and technical characteristics of treatments.
In total, 97 patients received a total of 298 AVVH treatments (3.1 ± 3.3 treatments per patient). Totally, 271/298 (91%) treatments were completed successfully. During an average treatment time of 9.5 ± 1.6 h with 4.2 ± 0.5 L/h -replacement fluid rate, urea reduction ratio was 23 ± 26% per 10-h treatment, and net ultrafiltration volume was 2.4 ± 1.3 L/treatment. Inpatient mortality was 32%, mean total hospital length of stay was 54 ± 47 days. Sixty-four out of 97 (66%) patients recovered renal function by discharge. Among those who transferred out of the ICU, 7/62 (11%) patients required readmission to the ICU after developing hypotension on iHD.
AVVH can serve as a transition therapy between CRRT and iHD in the ICU and has the potential to decrease total time on CRRT, improve patient mobility, and sustain low ICU readmission rates. Future study is needed to analyze the implications on resource use and cost of this modality.
连续肾脏替代疗法（CRRT）在重症监护病房（ICU）中被广泛应用，但在 CRRT 与间歇性血液透析（iHD）之间的转换方面尚无指南。加速静脉-静脉血液滤过（AVVH）是一种利用更高的血液滤过率（4-5 L/h）和更短的治疗时间（8-10 h）的方式，以“加速”在 CRRT 中通常在 24 小时内完成的清除和容量去除。我们研究了 AVVH 作为 CRRT 与 iHD 之间的过渡治疗，目的是减少 CRRT 的使用时间，并为需要肾脏替代治疗的血流动力学不稳定患者提供更渐进的过渡。
这是一项回顾性队列研究，描述了在学术性三级护理中心将 AVVH 整合到 CRRT 计划中的临床结果和质量倡议经验。感兴趣的结果包括死亡率、ICU 住院时间和再入院率，以及治疗的技术特征。
共有 97 名患者接受了总共 298 次 AVVH 治疗（每位患者 3.1 ± 3.3 次治疗）。总共 271/298（91%）次治疗成功完成。在平均治疗时间为 9.5 ± 1.6 h，以 4.2 ± 0.5 L/h 的置换液率进行治疗时，尿素清除率为每次 10 h 治疗 23 ± 26%，净超滤量为每次 2.4 ± 1.3 L/次。住院死亡率为 32%，平均总住院时间为 54 ± 47 天。97 名患者中有 64 名（66%）在出院时恢复了肾功能。在转出 ICU 的患者中，有 7/62（11%）名患者在接受 iHD 后出现低血压而再次转入 ICU。
AVVH 可作为 ICU 中 CRRT 与 iHD 之间的过渡治疗，有潜力减少 CRRT 的总使用时间，提高患者的活动能力，并维持较低的 ICU 再入院率。需要进一步的研究来分析这种方式对资源利用和成本的影响。
