Department of Medicine, University of Toronto, Toronto, ON, Canada.
Department of Critical Care Medicine, St. Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
J Crit Care. 2021 Apr;62:76-81. doi: 10.1016/j.jcrc.2020.11.003. Epub 2020 Nov 22.
Sustained low efficiency dialysis (SLED) has emerged as an alternative to continuous renal replacement therapy (CRRT) for the treatment of acute kidney injury (AKI) in critically ill patients. However, there is limited information on the short- and long-term outcomes of SLED compared to CRRT.
We conducted a retrospective cohort study of patients with AKI who commenced either SLED or CRRT in ICUs at a tertiary care hospital in Toronto, Canada. The primary outcome was 90-day all-cause mortality. Secondary outcomes included mortality at one year, and dialysis dependence at 90 days and one year. All outcomes were ascertained by linkage to provincial datasets.
We identified 284 patients, of whom 95 and 189 commenced SLED and CRRT, respectively. Compared to SLED recipients, more CRRT recipients were mechanically ventilated (96% vs 86%, p = 0.002) and receiving vasopressors (94% vs 84%, p = 0.01) at the time of RRT initiation. At 90 days following RRT initiation, 52 (55%) and 126 (67%) SLED and CRRT recipients, respectively, died (adjusted risk ratio (RR) 0.91, 95% CI 0.75-1.11). There was no inter-modality difference in time to death through 90 days (adjusted hazard ratio 0.90, 95% CI 0.64-1.27). Among patients surviving to Day 90, a higher proportion of SLED recipients remained RRT dependent (10 (23%) vs 6 (10%) CRRT recipients, adjusted RR 2.82, 95% CI 1.02-7.81). At one year, there was no difference in mortality or dialysis dependence.
Among critically ill patients with acute kidney injury, mortality at 90 days and one year was not different among patients initiating SLED as compared to CRRT.
持续低效率透析（SLED）已成为危重症患者急性肾损伤（AKI）治疗的连续肾脏替代治疗（CRRT）替代方法。然而，与 CRRT 相比，SLED 的短期和长期结果信息有限。
我们对加拿大多伦多一家三级保健医院 ICU 中开始接受 SLED 或 CRRT 的 AKI 患者进行了回顾性队列研究。主要结局为 90 天全因死亡率。次要结局包括一年时的死亡率以及 90 天和 1 年时的透析依赖率。所有结局均通过与省级数据集的链接确定。
我们确定了 284 例患者，其中 95 例和 189 例分别开始接受 SLED 和 CRRT。与 SLED 组相比，更多的 CRRT 组在开始 RRT 时接受机械通气（96%比 86%，p=0.002）和血管加压素（94%比 84%，p=0.01）。在开始 RRT 后 90 天，分别有 52（55%）和 126（67%）例 SLED 和 CRRT 组患者死亡（调整后的风险比（RR）0.91，95%CI 0.75-1.11）。在 90 天内，两种模式之间的死亡时间无差异（调整后的危险比 0.90，95%CI 0.64-1.27）。在存活至 90 天的患者中，SLED 组需要继续透析的比例更高（10[23%]比 6[10%]CRRT 组，调整后的 RR 2.82，95%CI 1.02-7.81）。在一年时，死亡率或透析依赖率没有差异。
在急性肾损伤的危重症患者中，与 CRRT 相比，开始 SLED 的患者在 90 天和一年时的死亡率没有差异。
