接受延长间歇性肾脏替代治疗的急性肾损伤患者的短期预后及其影响因素。

Short-term prognosis and influencing factors of patients with acute kidney injury treated with prolonged intermittent renal replacement therapy.

机构信息

Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Clinical Medical Research Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

出版信息

Int J Clin Pract. 2021 May;75(5):e14020. doi: 10.1111/ijcp.14020. Epub 2021 Jan 22.

DOI:10.1111/ijcp.14020

PMID:33426762

Abstract

BACKGROUND

Studies assessing prognosis after prolonged intermittent renal replacement therapy (PIRRT) for acute kidney injury (AKI) are scarce.

AIM

To assess the impact of PIRRT on AKI and factors associated with short-term prognosis.

METHODS

In this retrospective nested case-control study, AKI patients administered PIRRT in Shanghai General Hospital from 01/2012 to 10/2018 were assigned to the 30-day survivor and death groups. Surviving patients were further divided into the kidney recovery and non-recovery groups at 30 and 90 days post-discharge, respectively. Propensity score matching was performed.

RESULTS

Totally 576 patients were included in the non-matched study population, mortality and kidney recovery rates were 51.7% and 33.4%, respectively. After propensity score matching, there were 250 patients in each of the death and survival groups. Low PIRRT frequency (OR = 2.165, 95% CI = 1.178-3.978), infection (OR = 0.447, 95% CI = 0.251-0.795), number of damaged vital organs (OR = 0.478, 95% CI = 0.346-0.661), sodium (OR = 0.958, 95% CI = 0.928-0.988), total protein (OR = 1.047, 95% CI = 1.022-1.072), pre-dialysis thrombin time (TT; OR = 0.959, 95% CI = 0.936-0.983), pre-discharge glomerular filtration rate (GFR; OR = 1.024, 95% CI = 1.017-1.031) and admission ward [reference: renal ward; intensive care unit (OR = 0.042, 95% CI = 0.008-0.211); surgery (OR = 0.092, 95% CI = 0.018-0.465); medical (OR = 0.049, 95% C% CI = 0.009-0.259); other (OR = 0.097, 95% CI = 0.016-0.572)] independently predicted 30-day mortality. Peripherally inserted central catheter (OR = 13.970, 95% CI = 1.439-135.589), urea nitrogen (OR = 0.961, 95% CI = 0.933-0.990) and pre-discharge GFR (OR = 1.102, 95% CI = 1.067-1.137) independently predicted 30-day kidney recovery. Pre-dialysis Scr (OR = 0.997, 95% CI = 0.995-0.999), urea nitrogen (OR = 0.948, 95% CI = 0.912-0.986) and pre-discharge GFR (OR = 1.137 95% CI = 1.088-1.189) independently predicted 90-day kidney recovery.

CONCLUSIONS

PIRRT improves survival and kidney function recovery in AKI patients. In patients with previous GFR ≥ 30 mL/(min-1.73 m ) and no prior maintenance dialysis, PIRRT at 3-5 sessions/week might be appropriate.

摘要

背景

评估急性肾损伤（AKI）患者接受长时间间歇性肾脏替代治疗（PIRRT）后的预后的研究很少。

目的

评估 PIRRT 对 AKI 的影响以及与短期预后相关的因素。

方法

在这项回顾性巢式病例对照研究中，将 2012 年 1 月至 2018 年 10 月在上海总医院接受 PIRRT 的 AKI 患者分配到 30 天存活组和死亡组。存活患者分别在出院后 30 天和 90 天分为肾脏恢复组和非恢复组。进行倾向评分匹配。

结果

共有 576 例患者未进行匹配研究，死亡率和肾脏恢复率分别为 51.7%和 33.4%。进行倾向评分匹配后，死亡组和存活组各有 250 例患者。低 PIRRT 频率（OR=2.165，95%CI=1.178-3.978）、感染（OR=0.447，95%CI=0.251-0.795）、受损重要器官数量（OR=0.478，95%CI=0.346-0.661）、钠（OR=0.958，95%CI=0.928-0.988）、总蛋白（OR=1.047，95%CI=1.022-1.072）、透析前凝血酶时间（TT；OR=0.959，95%CI=0.936-0.983）、出院前肾小球滤过率（GFR；OR=1.024，95%CI=1.017-1.031）和入院科室[参考：肾科；重症监护病房（OR=0.042，95%CI=0.008-0.211）；外科（OR=0.092，95%CI=0.018-0.465）；内科（OR=0.049，95%CI=0.009-0.259）；其他（OR=0.097，95%CI=0.016-0.572）]独立预测 30 天死亡率。外周置入中心导管（OR=13.970，95%CI=1.439-135.589）、尿素氮（OR=0.961，95%CI=0.933-0.990）和出院前 GFR（OR=1.102，95%CI=1.067-1.137）独立预测 30 天肾脏恢复。透析前 Scr（OR=0.997，95%CI=0.995-0.999）、尿素氮（OR=0.948，95%CI=0.912-0.986）和出院前 GFR（OR=1.137，95%CI=1.088-1.189）独立预测 90 天肾脏恢复。