1 型心肾综合征所致急性肾损伤患者接受连续性肾脏替代治疗的预后。

Prognosis of Patients with Acute Kidney Injury due to Type 1 Cardiorenal Syndrome Receiving Continuous Renal Replacement Therapy.

机构信息

Department of Nephrology, Saitama Medical University, Saitama, Japan.

Division of Dialysis Center and Department of Nephrology, Saitama Medical University International Medical Center, Saitama, Japan.

出版信息

Cardiorenal Med. 2023;13(1):158-166. doi: 10.1159/000527111. Epub 2023 Mar 24.

DOI:10.1159/000527111

PMID:36966533

Abstract

INTRODUCTION

The prognosis of patients with acute kidney injury (AKI) caused by type 1 cardiorenal syndrome (CRS) requiring continuous renal replacement therapy (CRRT) is unclear. We investigated the in-hospital mortality and prognostic factors in these patients.

METHODS

We retrospectively identified 154 consecutive adult patients who received CRRT for AKI caused by type 1 CRS between January 1, 2013, and December 31, 2019. We excluded patients who underwent cardiovascular surgery and those with stage 5 chronic kidney disease. The primary outcome was in-hospital mortality. Cox proportional hazards analysis was performed to analyze independent predictors of in-hospital mortality.

RESULTS

The median age of patients at admission was 74.0 years (interquartile range: 63.0-80.0); 70.8% were male. The in-hospital mortality rate was 68.2%. Age ≥80 years (hazard ratio [HR], 1.87; 95% confidence interval [CI], 1.21-2.87; p = 0.004), previous hospitalization for acute heart failure (HR, 1.67; 95% CI, 1.13-2.46; p = 0.01), vasopressor or inotrope use (HR, 5.88; 95% CI, 1.43-24.1; p = 0.014), and mechanical ventilation at CRRT initiation (HR, 2.24; 95% CI, 1.46-3.45; p < 0.001) were associated with in-hospital mortality.

CONCLUSION

In our single-center study, the use of CRRT for AKI due to type 1 CRS was associated with high in-hospital mortality.

摘要

引言

1 型心肾综合征（CRS）导致急性肾损伤（AKI）并需要持续肾脏替代治疗（CRRT）的患者的预后尚不清楚。我们调查了这些患者的住院死亡率和预后因素。

方法

我们回顾性地确定了 2013 年 1 月 1 日至 2019 年 12 月 31 日期间因 1 型 CRS 导致 AKI 而接受 CRRT 的 154 例连续成年患者。我们排除了接受心血管手术的患者和患有 5 期慢性肾脏病的患者。主要结局是住院死亡率。进行 Cox 比例风险分析以分析住院死亡率的独立预测因素。

结果

患者入院时的中位年龄为 74.0 岁（四分位距：63.0-80.0）；70.8%为男性。住院死亡率为 68.2%。年龄≥80 岁（风险比 [HR]，1.87；95%置信区间 [CI]，1.21-2.87；p = 0.004）、急性心力衰竭既往住院治疗（HR，1.67；95%CI，1.13-2.46；p = 0.01）、血管加压素或正性肌力药使用（HR，5.88；95%CI，1.43-24.1；p = 0.014）和 CRRT 开始时机械通气（HR，2.24；95%CI，1.46-3.45；p < 0.001）与住院死亡率相关。