From the Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea.
ASAIO J. 2022 May 1;68(5):744-752. doi: 10.1097/MAT.0000000000001549. Epub 2021 Aug 28.
Continuous renal replacement therapy (CRRT) downtime is considered a quality indicator; however, it remains uncertain whether downtime affects outcomes. This study retrospectively investigated the impact of downtime on clinical outcomes. Patients were classified as downtime <20% or ≥20% of potential operative time over 4 days from CRRT initiation. Patients with ≥20% downtime were matched to those with <20% downtime using 1:2 propensity score matching. There were 88 patients with <20% downtime and 44 patients with ≥20% downtime. The cumulative effluent volume was lower in patients with ≥20% downtime (p < 0.001). The difference in levels of urea and creatinine widened over time (p = 0.004 and <0.001). At days 2 and 3, daily fluid balance differed (p = 0.046 and 0.031), and the levels of total carbon dioxide were lower in those with ≥20% downtime (p = 0.038 and 0.020). Based on our results, ≥20% downtime was not associated with increased 28 day mortality; however, a subgroup analysis showed the interaction between downtime and daily fluid balance (p = 0.004). In conclusion, increased downtime could impair fluid and uremic control and acidosis management. Moreover, the adverse effect of downtime on fluid control may increase mortality rate. Further studies are needed to verify the value of downtime in critically ill patients requiring CRRT.
连续性肾脏替代治疗 (CRRT) 的停机时间被认为是一个质量指标；然而，停机时间是否会影响结果仍不确定。本研究回顾性调查了停机时间对临床结果的影响。患者被分为停机时间<20%或在 CRRT 开始后 4 天内停机时间≥20%的潜在手术时间。停机时间≥20%的患者与停机时间<20%的患者进行 1:2 倾向评分匹配。<20%停机时间的患者有 88 例，停机时间≥20%的患者有 44 例。停机时间≥20%的患者累积流出量较低（p<0.001）。随着时间的推移，尿素和肌酐的水平差异扩大（p=0.004 和<0.001）。在第 2 天和第 3 天，每日液体平衡不同（p=0.046 和 0.031），停机时间≥20%的患者总二氧化碳水平较低（p=0.038 和 0.020）。根据我们的结果，停机时间≥20%与 28 天死亡率增加无关；然而，亚组分析显示停机时间和每日液体平衡之间存在交互作用（p=0.004）。总之，增加的停机时间可能会损害液体和尿毒症控制以及酸中毒管理。此外，停机时间对液体控制的不利影响可能会增加死亡率。需要进一步的研究来验证停机时间在需要 CRRT 的危重症患者中的价值。
