与儿童和青年成功脱离连续性肾脏替代治疗相关的因素：对肾脏病预后和实践模式研究网络肾脏登记系统的全球探索的分析。
Factors associated with successful liberation from continuous renal replacement therapy in children and young adults: analysis of the worldwide exploration of renal replacement outcomes collaborative in Kidney Disease Registry.
机构信息
Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
Carver College of Medicine, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA.
出版信息
Intensive Care Med. 2024 Jun;50(6):861-872. doi: 10.1007/s00134-024-07336-4. Epub 2024 Mar 4.
PURPOSE
Continuous renal replacement therapy (CRRT) is used for supportive management of acute kidney injury (AKI) and disorders of fluid balance (FB). Little is known about the predictors of successful liberation in children and young adults. We aimed to identify the factors associated with successful CRRT liberation.
METHODS
The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease study is an international multicenter retrospective study (32 centers, 7 nations) conducted from 2015 to 2021 in children and young adults (aged 0-25 years) treated with CRRT for AKI or FB disorders. Patients with previous dialysis dependence, tandem extracorporeal membrane oxygenation use, died within the first 72 h of CRRT initiation, and those who never had liberation attempted were excluded. Patients were categorized based on first liberation attempt: reinstituted (resumption of any dialysis within 72 h) vs. success (no receipt of dialysis for ≥ 72 h). Multivariable logistic regression was used to identify factors associated with successful CRRT liberation.
RESULTS
A total of 622 patients were included: 287 (46%) had CRRT reinstituted and 335 (54%) were successfully liberated. After adjusting for sepsis at admission and illness severity parameters, several factors were associated with successful liberation, including higher VIS (vasoactive-inotropic score) at CRRT initiation (odds ratio [OR] 1.35 [1.12-1.63]), higher PELOD-2 (pediatric logistic organ dysfunction-2) score at CRRT initiation (OR 1.71 [1.24-2.35]), higher urine output prior to CRRT initiation (OR 1.15 [1.001-1.32]), and shorter CRRT duration (OR 0.19 [0.12-0.28]).
CONCLUSIONS
Inability to liberate from CRRT was common in this multinational retrospective study. Modifiable and non-modifiable factors were associated with successful liberation. These results may inform the design of future clinical trials to optimize likelihood of CRRT liberation success.
目的
连续肾脏替代疗法（CRRT）用于支持急性肾损伤（AKI）和液体平衡（FB）紊乱的治疗。关于儿童和年轻成人成功撤机的预测因素知之甚少。本研究旨在确定与 CRRT 撤机成功相关的因素。
方法
全球肾脏病肾脏替代治疗结果协作研究（Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease study）是一项国际性多中心回顾性研究（32 个中心，7 个国家），于 2015 年至 2021 年在接受 CRRT 治疗 AKI 或 FB 紊乱的儿童和年轻成人（年龄 0-25 岁）中进行。排除先前依赖透析、使用体外膜氧合串联治疗、CRRT 启动后 72 小时内死亡以及从未尝试撤机的患者。根据首次撤机尝试将患者分为重新开始（72 小时内重新开始任何透析）和成功（72 小时内未接受透析）。采用多变量逻辑回归确定与 CRRT 成功撤机相关的因素。
结果
共纳入 622 例患者：287 例（46%）重新开始 CRRT，335 例（54%）成功撤机。在校正入院时脓毒症和疾病严重程度参数后，一些因素与成功撤机相关，包括 CRRT 启动时更高的 VIS（血管活性-正性肌力评分）（优势比 [OR] 1.35 [1.12-1.63]）、CRRT 启动时更高的 PELOD-2（儿科逻辑器官功能障碍-2）评分（OR 1.71 [1.24-2.35]）、CRRT 启动前更高的尿量（OR 1.15 [1.001-1.32]）和更短的 CRRT 持续时间（OR 0.19 [0.12-0.28]）。
结论
在这项多国家回顾性研究中，无法从 CRRT 撤机很常见。可改变和不可改变的因素与成功撤机相关。这些结果可能为未来优化 CRRT 撤机成功率的临床试验设计提供信息。
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