Duran Paula, Concepcion Luis A
Division of Nephrology and Hypertension, Baylor Scott & White Medical CenterTempleTexas.
College of Medicine, Texas A&M Health Science CenterTempleTexas.
Proc (Bayl Univ Med Cent). 2020 Apr 3;33(3):322-325. doi: 10.1080/08998280.2020.1743546. eCollection 2020 Jul.
Acute kidney injury (AKI) requiring dialysis is becoming more common. Several types of renal replacement therapies have been used, including continuous, intermittent, and prolonged intermittent renal replacement therapy (PIRRT). There is no clear difference between those therapies in terms of patient survival. The aim of this study was to describe a form of PIRRT (shift continuous veno-venous hemodialysis [CVVHD]) and the results of this technique in a population of patients with AKI requiring dialysis in a tertiary care center. We studied 302 patients with AKI requiring dialysis over a 3-year period. All patients were treated in the intensive care unit. There were 1709 treatments in the study. Shift CVVHD was done for 8 h daily using NxStage machines, with a bicarbonate base dialysate at a rate of 5 L/h. Demographics and laboratory data were obtained from the electronic medical record. Dialysis data were obtained from the dialysis run sheets. Patient mortality was 51.3%.The dialysis time was close to 8 h and the blood flow was 310 (± 43) mL/min. The mean arterial pressure was stable before and after the dialysis. The total ultrafiltration averaged 2934 mL per treatment; the ultrafiltration rate was 4.1 (± 3.1) mL/kg/h, and the ultrafiltration per hour was 359 (± 257.8) mL/h. The average dialysate potassium used was 2.9 mEq/L. The dose of dialysis was 57 (± 19) mL/kg/h. The urea reduction ratio was 48% (± 15%), the standardized KT/V (a measure of dialysis dose obtained by urea kinetic modeling) was 3.5 (± 0.9), and the equivalent renal urea clearance (EKR) was 9.8 (± 4.1) mL/min. The method produced a consistent reduction in the levels of blood urea nitrogen, creatinine, potassium, and phosphorous. The delivered dose of dialysis was stable during the observation period. In conclusion, shift CVVHD is effective in treating patients with AKI requiring dialysis and has a survival similar to that of continuous therapies with less intensive use of resources.
需要透析的急性肾损伤（AKI）正变得越来越常见。已经使用了几种类型的肾脏替代疗法，包括持续、间歇性和延长间歇性肾脏替代疗法（PIRRT）。这些疗法在患者生存率方面没有明显差异。本研究的目的是描述一种PIRRT形式（轮班连续性静脉-静脉血液透析[CVVHD]）及其在一家三级医疗中心需要透析的AKI患者群体中的应用结果。我们研究了302例在3年期间需要透析的AKI患者。所有患者均在重症监护病房接受治疗。本研究共进行了1709次治疗。使用NxStage机器每天进行8小时的轮班CVVHD，使用碳酸氢盐基透析液，流速为5L/h。人口统计学和实验室数据来自电子病历。透析数据来自透析运行记录单。患者死亡率为51.3%。透析时间接近8小时，血流量为310（±43）mL/分钟。透析前后平均动脉压稳定。每次治疗的总超滤量平均为2934mL；超滤率为4.1（±3.1）mL/kg/h，每小时超滤量为359（±257.8）mL/h。使用的透析液平均钾含量为2.9mEq/L。透析剂量为57（±19）mL/kg/h。尿素清除率为48%（±15%）标准KT/V（通过尿素动力学模型获得的透析剂量测量值）为3.5（±0.9），等效肾脏尿素清除率（EKR）为9.8（±4.1）mL/分钟。该方法使血尿素氮、肌酐、钾和磷水平持续降低。在观察期内透析的输送剂量稳定。总之，轮班CVVHD对治疗需要透析的AKI患者有效，其生存率与持续疗法相似，但资源使用强度较低。
