Department of Paediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi, India.
Paediatr Int Child Health. 2021 May;41(2):137-144. doi: 10.1080/20469047.2021.1874201. Epub 2021 Jan 17.
: In critically ill children, sepsis-associated acute kidney injury (SA-AKI) has significant morbidity and mortality.: To estimate whether early initiation of peritoneal dialysis (PD) has a better short-term outcome than standard PD.: Early PD ( = 25) was defined as a need for PD in Kidney Disease: Improving Global Outcomes (KDIGO) stage 2 AKI, while those fulfilling the criteria for stage 3 KDIGO were categorised as a standard PD group ( = 25). The primary outcome measure was the estimated glomerular filtration rate (eGFR) at discharge or at 4 weeks after initiation of PD, whichever occurred earlier.: A prospective cohort of 50 children (32 boys) aged 2 months to 16 years with SA-AKI who underwent PD were recruited. The most frequent indication for PD was fluid overload (40%), followed by persistent metabolic acidosis (36%). Children in the early PD group had lower creatinine and higher eGFR at discharge/4-week follow-up ( < 0.001). The duration of PD was less if it was commenced early ( < 0.04); 24 of 25 (96%) children in the early PD group were off PD within 6 days of initiation compared with 13 of 25 (52%) in the standard PD group ( < 0.001).: Compared with standard PD, early PD in SA-AKI resulted in a favourable renal outcome, decreased duration of PD and early discontinuation of dialysis. : AKI: acute kidney injury; CRRT: continuous renal replacement therapy; CS-AKI: cardiac surgery-associated acute kidney injury; eGFR: estimated glomerular filtration rate; ELAIN: early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury; ESCAPE: effect of strict blood pressure control and ACE inhibition on the progression of chronic kidney disease in paediatric patients; HIC: high-income countries; ISN: international society of nephrology; KDIGO: Kidney Disease: Improving Global Outcomes; LMIC: low- to middle-income countries; PD: peritoneal dialysis; PICU: paediatric intensive care unit; RRT: renal replacement therapy; SA-AKI: sepsis-associated acute kidney injury; SYL: Saving Young Lives; SOFA: sequential (sepsis-related) organ failure assessment score; STARRT-AKI: standard versus accelerated initiation of renal replacement therapy in acute kidney injury.
在危重症患儿中，与脓毒症相关的急性肾损伤（SA-AKI）具有显著的发病率和死亡率。本研究旨在评估早期开始腹膜透析（PD）是否比标准 PD 具有更好的短期预后。早期 PD（=25 例）定义为符合 KDIGO 急性肾损伤 2 期标准需要 PD，而符合 KDIGO 3 期标准的患者则归类为标准 PD 组（=25 例）。主要观察指标为 PD 开始后更早的出院时或 4 周时的估计肾小球滤过率（eGFR）。
这项前瞻性队列研究纳入了 50 例（男 32 例）年龄 2 个月至 16 岁的患有 SA-AKI 行 PD 的患儿。PD 的最常见适应证为液体超负荷（40%），其次为持续代谢性酸中毒（36%）。早期 PD 组患儿在出院/4 周随访时的肌酐水平更低，eGFR 更高（<0.001）。如果早期开始 PD，则 PD 持续时间更短（<0.04）；25 例早期 PD 组患儿中，24 例（96%）在开始 PD 后 6 天内停止 PD，而 25 例标准 PD 组患儿中，仅 13 例（52%）（<0.001）。与标准 PD 相比，SA-AKI 患儿中早期 PD 可获得更好的肾脏预后，PD 持续时间更短，透析更早停止。
急性肾损伤；CRRT：连续肾脏替代疗法；CS-AKI：心脏手术后相关的急性肾损伤；eGFR：估计肾小球滤过率；ELAIN：危重症患者急性肾损伤中肾脏替代治疗的早期与晚期开始；ESCAPE：严格血压控制和 ACE 抑制对儿科患者慢性肾脏病进展的影响；HIC：高收入国家；ISN：国际肾脏病学会；KDIGO：肾脏疾病：改善全球结果；LMIC：中低收入国家；PD：腹膜透析；PICU：儿科重症监护病房；RRT：肾脏替代治疗；SA-AKI：脓毒症相关急性肾损伤；SYL：拯救年轻生命；SOFA：序贯（脓毒症相关）器官衰竭评估评分；STARRT-AKI：急性肾损伤中标准与加速启动肾脏替代治疗。
