Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Section of Nephrology, Department of Medicine, West Virginia University, Morgantown, WV, USA.
J Nephrol. 2022 Mar;35(2):585-595. doi: 10.1007/s40620-021-01097-9. Epub 2021 Jun 23.
Little is known about the process of deciding to discontinue continuous renal replacement therapy (CRRT) in patients with acute kidney injury (AKI) and the impact of CRRT duration on outcomes.
We report the clinical parameters of prolonged CRRT exposure and predictors of doubling of serum creatinine or need for dialysis at 90 days after CRRT with propensity score matching, including covariates that were likely to influence patients in the prolonged CRRT group.
Among 104 survey responders, most use urine output (87%) to guide CRRT discontinuation, 24% use improvement in clinical or hemodynamic status. In the cohort study, of 854 included patients, 465 participated in the assessment of kidney recovery. Patients with prolonged CRRT had higher SOFA scores (11.9 vs. 11.2) and were more likely to be mechanically ventilated (99% vs. 84%) at CRRT initiation compared to patients without prolonged CRRT, p-value < 0.05. In multivariable logistic regression, daily urine output and cumulative fluid balance leading to CRRT discontinuation or day seven were independently associated with lower [OR 0.87 per 200 ml/day increase] and higher odds [OR 1.03 per 1-L increase] of requiring prolonged CRRT, respectively. After propensity score matching, prolonged exposure to CRRT was independently associated with increased risk of doubling serum creatinine or dialysis at 90 days, OR 3.1 (95% CI 1.23-8.3 p = 0.017).
Resolution of critical illness and signs of kidney recovery are important factors when considering CRRT discontinuation. Prolonged CRRT exposure may be associated with less chance of kidney recovery among survivors.
对于急性肾损伤（AKI）患者停止连续性肾脏替代治疗（CRRT）的决策过程以及 CRRT 持续时间对结局的影响知之甚少。
我们报告了延长 CRRT 暴露的临床参数，并通过倾向评分匹配，包括可能影响延长 CRRT 组患者的协变量，预测了 CRRT 后 90 天血清肌酐加倍或需要透析的情况。
在 104 名调查应答者中，大多数使用尿量（87%）来指导 CRRT 停止，24%使用临床或血流动力学状态的改善。在队列研究中，854 名纳入患者中，465 名患者接受了肾脏恢复评估。与无延长 CRRT 的患者相比，延长 CRRT 的患者在 CRRT 开始时的 SOFA 评分更高（11.9 对 11.2），更有可能接受机械通气（99%对 84%），p 值<0.05。在多变量逻辑回归中，导致 CRRT 停止的每日尿量和累积液体平衡以及第 7 天与需要延长 CRRT 的几率较低[每增加 200ml/天的 OR 0.87]和较高[每增加 1L 的 OR 1.03]独立相关。在倾向评分匹配后，延长 CRRT 暴露与 90 天内血清肌酐加倍或透析的风险增加独立相关，OR 3.1（95%CI 1.23-8.3，p=0.017）。
当考虑停止 CRRT 时，危重疾病的缓解和肾脏恢复的迹象是重要因素。幸存者中延长 CRRT 暴露可能与肾脏恢复的机会减少有关。
