Jawa Natasha A, Silver Samuel A, Holden Rachel M, Scott Stephen H, Day Andrew G, Norman Patrick A, Kwan Benjamin Y M, Maslove David M, Muscedere John, Boyd J Gordon
Centre for Neuroscience Studies, School of Medicine, Queen's Health Sciences, Queen's University, Kingston, ON, Canada.
Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada.
Can J Kidney Health Dis. 2023 Aug 24;10:20543581231192743. doi: 10.1177/20543581231192743. eCollection 2023.
Acute kidney injury (AKI) resulting in kidney replacement therapy is rising among critically ill adults. Long-term kidney replacement therapy and critical illness are independently linked to acute and prolonged cognitive impairment, and structural brain pathology. Poor regional cerebral oxygenation (rSO) may be a contributing factor.
To assess the feasibility of testing the association between intradialytic rSO and acute and long-term neurological outcomes.
Longitudinal observational study.
We enrolled patients initiating continuous kidney replacement therapy or intermittent hemodialysis in the Kingston Health Sciences Centre (KHSC) Intensive Care Unit (ICU).
rSO was monitored during the first 72 hours of continuous kidney replacement therapy or throughout each intermittent hemodialysis session. We measured acute neurological impairment by daily delirium screening and long-term neurocognitive outcomes using the Kinarm robot, Repeatable Battery for the Assessment of Neuropsychological Status, and brain magnetic resonance imaging.
Of 484 ICU patients, 26 met the screening criteria. Two declined, and 13 met at least one exclusion criteria. Eleven patients were enrolled. Eight died in ICU, one died 2 months after discharge, and one declined follow-up. Data capture rates were high: rSO/vitals (91.3%), and delirium screening and demographics (100%). Longitudinal testing was completed in 50% (1 of 2) of survivors.
Enrollment was low due to a variety of factors, limiting our ability to evaluate long-term outcomes.
rSO and delirium data collection is feasible in critically ill patients undergoing kidney replacement therapy; high mortality limits follow-up.
在危重症成年患者中，需要进行肾脏替代治疗的急性肾损伤（AKI）的发生率正在上升。长期肾脏替代治疗和危重症分别与急性和持续性认知障碍以及脑结构病变相关。局部脑氧合（rSO）不佳可能是一个促成因素。
评估测试透析期间rSO与急性及长期神经学结局之间关联的可行性。
纵向观察性研究。
我们纳入了在金斯顿健康科学中心（KHSC）重症监护病房（ICU）开始接受持续肾脏替代治疗或间歇性血液透析的患者。
在持续肾脏替代治疗的前72小时或每次间歇性血液透析期间监测rSO。我们通过每日谵妄筛查来测量急性神经功能障碍，并使用Kinarm机器人、可重复神经心理状态评估量表和脑磁共振成像来测量长期神经认知结局。
在484名ICU患者中，26名符合筛查标准。2名拒绝参与，13名至少符合一项排除标准。11名患者被纳入研究。8名在ICU死亡，1名在出院后2个月死亡，1名拒绝随访。数据捕获率很高：rSO/生命体征（91.3%），以及谵妄筛查和人口统计学数据（100%）。50%（2名中的1名）幸存者完成了纵向测试。
由于多种因素，入组人数较少，限制了我们评估长期结局的能力。
对于接受肾脏替代治疗的危重症患者，rSO和谵妄数据收集是可行的；高死亡率限制了随访。
