Naorungroj Thummaporn, Neto Ary Serpa, Zwakman-Hessels Lara, Yanase Fumitaka, Eastwood Glenn, Murugan Raghavan, Kellum John A, Bellomo Rinaldo
Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
Department of Intensive Care, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Nephrol Dial Transplant. 2021 May 27;36(6):1112-1119. doi: 10.1093/ndt/gfaa032.
In patients treated with continuous renal replacement therapy (CRRT), early net ultrafiltration (NUF) rates may be associated with differential outcomes. We tested whether higher early NUF rates are associated with increased mortality in CRRT patients.
We performed a retrospective, observational study of all patients treated with CRRT within 14 days of intensive care unit admission. We defined the early (first 48 h) NUF rate as the volume of fluid removed per hour adjusted for patient body weight and analysed as a categorical variable (>1.75, 1.01-1.75 and <1.01 mL/kg/h). The primary outcome was 28-day mortality. To deal with competing risk, we also compared different time epochs.
We studied 347 patients {median age 64 [interquartile range (IQR) 53-71] years and Acute Physiology and Chronic Health Evaluation III score 73 [IQR 54-90]}. Compared with NUF rates <1.01 mL/kg/h, NUF rates >1.75 mL/kg/h were associated with greater mortality rates in each epoch: Days 0-5, adjusted hazard ratio (aHR) 1.27 [95% confidence interval (CI) 1.21-1.33]; Days 6-10, aHR 1.62 (95% CI 1.55-1.68); Days 11-15, aHR 1.87 (95% CI 1.79-1.94); Days 16-26, aHR 1.92 (95% CI 1.84-2.01) and Days 27-28, aHR 4.18 (95% CI 3.98-4.40). For every 0.5 mL/kg/h NUF rate increase, mortality similarly increased during these epochs.
Compared with early NUF rates <1.01 mL/kg/h, NUF rates >1.75 mL/kg/h are associated with increased mortality. These observations provide the rationale for clinical trials to confirm or refute these findings.
在接受连续性肾脏替代治疗（CRRT）的患者中，早期净超滤（NUF）率可能与不同的预后相关。我们测试了较高的早期NUF率是否与CRRT患者死亡率增加有关。
我们对重症监护病房入院14天内接受CRRT治疗的所有患者进行了一项回顾性观察研究。我们将早期（最初48小时）NUF率定义为根据患者体重调整后的每小时液体清除量，并作为分类变量进行分析（>1.75、1.01 - 1.75和<1.01 mL/kg/h）。主要结局是28天死亡率。为处理竞争风险，我们还比较了不同时间段。
我们研究了347例患者{中位年龄64岁[四分位间距（IQR）53 - 71岁]，急性生理与慢性健康状况评价III评分73分[IQR 54 - 90分]}。与<1.01 mL/kg/h的NUF率相比，>1.75 mL/kg/h的NUF率在每个时间段都与更高的死亡率相关：第0 - 5天，调整后风险比（aHR）1.27[95%置信区间（CI）1.21 - 1.33]；第6 - 10天，aHR 1.62（95% CI 1.55 - 1.68）；第11 - 15天，aHR 1.87（95% CI 1.79 - 1.94）；第16 - 26天，aHR 1.92（95% CI 1.84 - 2.01）；第27 - 28天，aHR 4.18（95% CI 3.98 - 4.40）。在这些时间段内，每增加0.5 mL/kg/h的NUF率，死亡率同样增加。
与<1.01 mL/kg/h的早期NUF率相比，>1.75 mL/kg/h的NUF率与死亡率增加相关。这些观察结果为临床试验证实或反驳这些发现提供了理论依据。
