Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany.
Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany.
J Crit Care. 2024 Oct;83:154846. doi: 10.1016/j.jcrc.2024.154846. Epub 2024 Jun 26.
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can result in severe respiratory acidosis. Metabolic compensation is primarily achieved by renal retention of bicarbonate. The extent to which acute kidney injury (AKI) impairs the kidney's capacity to compensate for respiratory acidosis remains unclear.
This retrospective analysis covers clinical data between January 2009 and December 2021 for 498 ICU patients with AECOPD and need for respiratory support.
278 patients (55.8%) presented with or developed AKI. Patients with AKI exhibited higher 30-day-mortality rates (14.5% vs. 4.5% p = 0.001), longer duration of mechanical ventilation (median 90 h vs. 14 h; p = 0.001) and more severe hypercapnic acidosis (pH 7.23 vs. 7.28; pCO 68.5 mmHg vs. 61.8 mmHg). Patients with higher AKI stages exhibited lower HCO/pCO ratios and did not reach expected HCO levels. In a mixed model analysis with random intercept per patient we analyzed the association of pCO (independent) and HCO (dependent variable). Lower estimates for averaged change in HCO were observed in patients with more severe AKI.
AKI leads to poor outcomes and compromises metabolic compensation of respiratory acidosis in ICU patients with AECOPD. While buffering agents may aid compensation for severe AKI, their use should be approached with caution.
慢性阻塞性肺疾病（COPD）急性加重（AECOPD）可导致严重的呼吸性酸中毒。代谢代偿主要通过肾脏保留碳酸氢盐来实现。急性肾损伤（AKI）对肾脏代偿呼吸性酸中毒能力的损害程度尚不清楚。
本回顾性分析涵盖了 2009 年 1 月至 2021 年 12 月期间在需要呼吸支持的 498 例 ICU 中 AECOPD 患者的临床数据。
278 例患者（55.8%）出现或发展为 AKI。AKI 患者的 30 天死亡率更高（14.5% vs. 4.5%，p = 0.001），机械通气时间更长（中位数 90 h vs. 14 h，p = 0.001），高碳酸血症更严重（pH 7.23 vs. 7.28；pCO 68.5 mmHg vs. 61.8 mmHg）。AKI 分期较高的患者 HCO/pCO 比值较低，且未达到预期的 HCO 水平。在一项针对每位患者的随机截距混合模型分析中，我们分析了 pCO（独立）和 HCO（因变量）的关联。在 AKI 更严重的患者中，HCO 的平均变化估计值较低。
AKI 导致 ICU 中 AECOPD 患者预后不良，并损害呼吸性酸中毒的代谢代偿。虽然缓冲剂可能有助于代偿严重的 AKI，但应谨慎使用。
