心脏手术后急性肾损伤：与连续肾脏替代治疗相比持续低效率。

Acute kidney injury after cardiac surgery: Sustained low efficiency compared to continuous renal replacement therapy.

机构信息

Department of Anesthesiology & Critical Care, Hospital Universitari de Girona Dr J Trueta, University of Girona, Institut d'Investigació Biomédica de Girona (IDIBGI), Spain; Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.

Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Ontario, Canada.

出版信息

J Clin Anesth. 2022 May;77:110642. doi: 10.1016/j.jclinane.2021.110642. Epub 2021 Dec 23.

DOI:10.1016/j.jclinane.2021.110642

PMID:34954555

Abstract

STUDY OBJECTIVE

Sustained low efficiency dialysis (SLED) has been introduced as a mode of renal replacement therapy (RRT) for treating severe cardiac surgery-associated acute kidney injury (CSA-AKI) at some hospitals; SLED is performed using intermittent hemodialysis (IHD) devices but differs from conventional IHD in its duration and intensity. However, there are limited data comparing SLED against more conventional continuous RRT methods. We conducted a retrospective cohort study to compare outcomes of patients with severe CSA-AKI after an institutional transition from continuous RRT to SLED.

DESIGN

Following research ethics approval, we conducted a retrospective cohort study of patients with severe CSA-AKI requiring RRT.

SETTING

Cardiac Intensive Care Unit at the Toronto General Hospital (Toronto, Ontario, Canada) from 1 January 1999 to 31 December 2011.

PATIENTS

351 consecutive patients with severe CSA-AKI requiring RRT after cardiac surgery.

INTERVENTIONS

The RRT mode was continuous RRT before 31 March 2008, and SLED after 1 April 2008.

MEASUREMENTS

The primary outcome was low-cardiac output syndrome (LCOS) and the main secondary outcome was associated costs. Propensity score matched-pairs analyses were used to compare the outcomes of patients in the continuous RRT period versus the SLED period.

MAIN RESULTS

There were 268 patients treated with continuous RRT and 83 patients treated with SLED. The SLED group had a higher weight, higher baseline hemoglobin concentration, and higher prevalence of obstructive lung disease. In propensity score match-pairs analysis (n = 148), the SLED group experienced similar odds of low cardiac output syndrome (odds ratio [OR] 1.06, 95% CI 0.68 to 1.67), death (OR 1.09, 0.94 to 1.28), acute stroke (OR 0.97, 0.83 to 1.13), myocardial infarction (OR 0.92, 0.84 to 1.01). The use of SLED was associated with a reduced cost compared to continuous RRT. The cost differential for 83 treated patients was CAD$130,974 (CAD$178,159.50 vs CAD$309,133.50) in favor of SLED.

CONCLUSIONS

An institutional transition from continuous RRT to SLED, was associated with a significant lower cost with the use of SLED, while maintaining comparable postoperative outcomes in CSA-AKI patients.

摘要

研究目的

在一些医院，持续低效率透析（SLED）已被引入作为治疗严重心脏手术后相关急性肾损伤（CSA-AKI）的肾脏替代治疗（RRT）模式；SLED 使用间歇性血液透析（IHD）设备进行，但与传统 IHD 在持续时间和强度上有所不同。然而，与更传统的连续 RRT 方法相比，比较 SLED 的数据有限。我们进行了一项回顾性队列研究，比较了机构从连续 RRT 过渡到 SLED 后严重 CSA-AKI 患者的结局。

设计

在获得研究伦理批准后，我们对需要 RRT 的严重 CSA-AKI 患者进行了回顾性队列研究。

地点

多伦多总医院（加拿大安大略省多伦多市）心脏重症监护病房，1999 年 1 月 1 日至 2011 年 12 月 31 日。

患者

351 例严重 CSA-AKI 患者，心脏手术后需要 RRT。

干预措施

RRT 模式在 2008 年 3 月 31 日前为连续 RRT，2008 年 4 月 1 日后为 SLED。

测量

主要结局是低心输出综合征（LCOS），主要次要结局是相关成本。采用倾向评分匹配对分析比较连续 RRT 期和 SLED 期患者的结局。

主要结果

268 例患者接受连续 RRT 治疗，83 例患者接受 SLED 治疗。SLED 组体重较高，基线血红蛋白浓度较高，阻塞性肺病患病率较高。在倾向评分匹配对分析（n=148）中，SLED 组发生低心输出综合征的几率相似（比值比 [OR] 1.06，95%置信区间 0.68 至 1.67）、死亡（OR 1.09，0.94 至 1.28）、急性中风（OR 0.97，0.83 至 1.13）、心肌梗死（OR 0.92，0.84 至 1.01）。与连续 RRT 相比，使用 SLED 可降低成本。83 例治疗患者的成本差异为 CAD$130,974（CAD$178,159.50 比 CAD$309,133.50），SLED 更具优势。