Abdel-Rahman Emaad M, Casimir Ernst, Lyons Genevieve R, Ma Jennie Z, Gautam Jitendra K
Division of Nephrology, University of Virginia, Charlottesville, VA 22908, USA.
Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22908, USA.
J Clin Med. 2022 Jun 1;11(11):3147. doi: 10.3390/jcm11113147.
Identifying modifiable predictors of outcomes for cases of acute kidney injury requiring hemodialysis (AKI-D) will allow better care of patients with AKI-D. All patients with AKI-D discharged to University of Virginia (UVA) outpatient HD units between 1 January 2017 to 31 December 2019 (n = 273) were followed- for up to six months. Dialysis-related parameters were measured during the first 4 weeks of outpatient HD to test the hypothesis that modifiable factors during dialysis are associated with AKI-D outcomes of recovery, End Stage Kidney Disease (ESKD), or death. Patients were 42% female, 67% Caucasian, with mean age 62.8 ± 15.4 years. Median number of dialysis sessions was 11 (6-15), lasting 3.6 ± 0.6 h. At 90 days after starting outpatient HD, 45% recovered, 45% were declared ESKD and 9.9% died, with no significant changes noted between three and six months. Patients who recovered, died or were declared ESKD experienced an average of 9, 10 and 16 intradialytic hypotensive (IDH) episodes, respectively. More frequent IDH episodes were associated with increased risk of ESKD ( = 0.01). A one liter increment in net ultrafiltration was associated with 54% increased ratio of ESKD ( = 0.048). Optimizing dialysis prescription to decrease frequency of IDH episodes and minimize UF, and close monitoring of outpatient dialysis for patients with AKI-D, are crucial and may improve outcomes for these patients.
识别急性肾损伤需血液透析（AKI-D）病例预后的可改变预测因素，将有助于更好地护理AKI-D患者。对2017年1月1日至2019年12月31日期间出院至弗吉尼亚大学（UVA）门诊血液透析单元的所有AKI-D患者（n = 273）进行了长达6个月的随访。在门诊血液透析的前4周测量与透析相关的参数，以检验透析期间的可改变因素与AKI-D恢复、终末期肾病（ESKD）或死亡预后相关的假设。患者中42%为女性，67%为白种人，平均年龄62.8±15.4岁。透析疗程的中位数为11（6 - 15）次，每次持续3.6±0.6小时。开始门诊血液透析90天后，45%的患者恢复，45%被宣布为ESKD，9.9%死亡，3至6个月期间无显著变化。恢复、死亡或被宣布为ESKD的患者分别平均经历了9次、10次和16次透析期间低血压（IDH）发作。更频繁的IDH发作与ESKD风险增加相关（ = 0.01）。净超滤量每增加1升，ESKD的比例增加54%（ = 0.048）。优化透析处方以减少IDH发作频率并使超滤量最小化，以及密切监测AKI-D患者的门诊透析情况至关重要，这可能会改善这些患者的预后。
