Scherer Patricia Faria, Iizuka Ilson Jorge, Ammirati Adriano Luiz, Doher Marisa Petrucelli, Matsui Thais Nemoto, Dos Santos Bento Fortunato Cardoso, Monte Julio Cesar Martins, Batista Marcelo Costa, Pereira Virgilio Gonçalves, Dos Santos Oscar Fernando Pavão, Durão Marcelino de Souza
Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Int J Artif Organs. 2021 Apr;44(4):223-228. doi: 10.1177/0391398820952801. Epub 2020 Sep 10.
BACKGROUND/AIMS: Continuous renal replacement therapies (CRRT) are initially employed in patients with acute kidney injury (AKI) in ICU setting. After the period of serious illness, hemodialysis is usually used as a mode of transition from CRRT. Intermittent hemodiafiltration (HDF) is not commonly applied in this scenario.
To evaluate the feasibility of using HDF as transition therapy after CVVHDF in critically patients with AKI.
An observational and prospective pilot study was conducted in ICU patients with dialysis-requiring AKI. Patients were initially treated with CVVHDF and, after medical improvement, those who still needed renal replacement therapy were switched to HDF treatment.
Ten Patients underwent 53 HDF sessions (mean of 5.3 sessions/patient). The main cause of renal dysfunction was sepsis ( = 7; 70%). The APACHE II mean score was 27.6 ± 6.9. During HDF treatment, the urea reduction ratio was 64.5 ± 7.5%, for β-2 microglobulin serum levels the percentage of decrease was 42.0 ± 7.8%, and for Cystatin C was 36.2 ± 6.9%. Five episodes of arterial hypotension occurred (9.4% of sessions). There were 20 episodes of electrolytic disturbance (37.7% of sessions), mainly hypophosphatemia. No pyrogenic or suggestive episode of bacteremia was observed.
Hemodiafiltration was safe and efficient to treat critically ill patients with acute kidney injury during the transition phase from continuous to intermittent dialysis modality. Special attention should be paid regarding the occurrence of electrolytic disturbance, mainly hypophosphatemia.
背景/目的：连续性肾脏替代治疗（CRRT）最初用于重症监护病房（ICU）中急性肾损伤（AKI）的患者。在重病期过后，血液透析通常作为从CRRT过渡的模式。间歇性血液透析滤过（HDF）在这种情况下并不常用。
评估在AKI重症患者中使用HDF作为CVVHDF后过渡治疗的可行性。
对需要透析的AKI的ICU患者进行了一项观察性前瞻性试点研究。患者最初接受CVVHDF治疗，病情改善后，仍需要肾脏替代治疗的患者改为接受HDF治疗。
10例患者接受了53次HDF治疗（平均每位患者5.3次）。肾功能不全的主要原因是脓毒症（n = 7；70%）。APACHE II平均评分为27.6±6.9。在HDF治疗期间，尿素清除率为64.5±7.5%，β-2微球蛋白血清水平下降百分比为42.0±7.8%，胱抑素C为36.2±6.9%。发生了5次动脉低血压事件（占治疗次数的9.4%）。有20次电解质紊乱事件（占治疗次数的37.7%），主要是低磷血症。未观察到发热或疑似菌血症事件。
在从连续性透析模式过渡到间歇性透析模式的阶段，血液透析滤过治疗急性肾损伤的重症患者是安全有效的。应特别关注电解质紊乱的发生，主要是低磷血症。
