Piotte Julie, Louis Félix, Buyansky Dimitry, Mereniuk Eric, Lévesque Renée, Wald Ron, Cailhier Jean-François, Côté Jean-Maxime, Beaubien-Souligny William
Department of Medicine, Université de Montréal, Montréal, Canada.
Department of Medicine, Université de Sherbrooke, Montréal, Canada.
Kidney Int Rep. 2022 Aug 24;7(11):2376-2387. doi: 10.1016/j.ekir.2022.08.007. eCollection 2022 Nov.
Online hemodiafiltration (HDF) has been increasingly used for improved clearance of middle molecular weight toxins. The impact of this mode of clearance is unknown in critically ill patients. We aimed to determine whether the use of HDF in acute kidney injury (AKI) is associated with lower mortality and improved kidney recovery up to 90 days after initiation of therapy.
Single-center retrospective cohort study using data from 2017 to 2020 of adults with AKI who initiated intermittent renal replacement therapy (IRRT) in the intensive care unit (ICU), using either hemodialysis (HD) or HDF depending on the maintenance status of the water system without regards for patient characteristics. We assessed association with patient-events and session-events using time-dependent Cox models and general estimating equations models, respectively.
We included 182 adults with AKI for whom 848 IRRT sessions were performed in the ICU. The 90-day mortality rate was 43 of 182 (24.6%). There was no significant association with the use of HDF and mortality (adjusted hazard ratio [aHR]: 0.85 (0.43; 1.67) = 0.64), kidney recovery (aHR: 1.18 (0.76; 1.84) = 0.47), or intradialytic hypotension (adjusted odds ratio [aOR]: 0.91 confidence interval [CI]: 0.64-1.28 = 0.58). HDF treatment was associated with a lower rate of subsequent vasopressor use (aOR: 0.60 CI: 0.36-0.99 = 0.047) and a greater reduction of the neutrophil-to-lymphocyte ratio (NLR) following the first session (-15.0% vs. +5.1%, = 0.047) but was also associated with increased risk of filter thrombosis during treatment (aOR: 2.42 CI: 1.67-3.50 < 0.001).
The use of HDF in the setting of AKI was not associated with a differential risk of mortality or kidney recovery.
在线血液透析滤过（HDF）已越来越多地用于改善中分子量毒素的清除。这种清除方式对危重症患者的影响尚不清楚。我们旨在确定在急性肾损伤（AKI）中使用HDF是否与降低死亡率以及改善治疗开始后90天内的肾脏恢复情况相关。
采用单中心回顾性队列研究，使用2017年至2020年在重症监护病房（ICU）开始间歇性肾脏替代治疗（IRRT）的AKI成年患者的数据，根据水系统的维护状况使用血液透析（HD）或HDF，而不考虑患者特征。我们分别使用时间依赖性Cox模型和广义估计方程模型评估与患者事件和治疗时段事件的关联。
我们纳入了182例AKI成年患者，在ICU为他们进行了848次IRRT治疗。182例患者中90天死亡率为43例（24.6%）。使用HDF与死亡率（调整后风险比[aHR]：0.85（0.43；1.67），P = 0.64）、肾脏恢复（aHR：1.18（0.76；1.84），P = 0.47）或透析中低血压（调整后优势比[aOR]：0.91，置信区间[CI]：0.64 - 1.28，P = 0.58）均无显著关联。HDF治疗与随后使用血管升压药的发生率较低（aOR：0.60，CI：0.36 - 0.99，P = 0.047）以及首次治疗后中性粒细胞与淋巴细胞比值（NLR）的更大降幅相关（-15.0%对 +5.1%，P = 0.047），但也与治疗期间滤器血栓形成风险增加相关（aOR：2.42，CI：1.67 - 3.50，P < 0.001）。
在AKI情况下使用HDF与死亡率或肾脏恢复的差异风险无关。
