行脉外膜肺氧合的患者中连续肾脏替代疗法与腹膜透析作为肾脏替代治疗方式的结局比较。

Outcomes of continuous renal replacement therapy versus peritoneal dialysis as a renal replacement therapy modality in patients undergoing Venoarterial extracorporeal membrane oxygenation.

机构信息

Division of Nephrology, Department of Medicine, Thammasat University Hospital, Pathum Thani, Thailand; Nephrology Unit, Central Chest Institute of Thailand, Nonthaburi, Thailand.

Nephrology Unit, Central Chest Institute of Thailand, Nonthaburi, Thailand.

出版信息

J Crit Care. 2024 Dec;84:154895. doi: 10.1016/j.jcrc.2024.154895. Epub 2024 Aug 7.

DOI:10.1016/j.jcrc.2024.154895

PMID:39116642

Abstract

INTRODUCTION

The optimal modality for renal replacement therapy (RRT) in patients venoarterial extracorporeal membrane oxygenation (VA-ECMO) remains unclear. This study aimed to compare outcomes between continuous renal replacement therapy (CRRT) and peritoneal dialysis (PD) in VA-ECMO patients.

METHODS

This single-center retrospective study included VA-ECMO patients who developed AKI and subsequently required CRRT or PD. Data on patient demographics, comorbidities, clinical characteristics, RRT modality, and outcomes were collected. The primary outcome was in-hospital mortality, with secondary outcomes including length of stays, RRT durations, and complications associated with RRT.

RESULTS

A total of 43 patients were included (72.1% male, mean age 58.2 ± 15.7 years). Of these, 21 received CRRT and 22 received PD during ECMO therapy. In-hospital mortality rates did not significantly differ between CRRT and PD groups (80.9% vs 90.9%, p = 0.35). However, PD was associated with a higher incidence of catheter-related complications, including malposition (31.8% vs 4.7%, p = 0.046), infection (22.7% vs 4.7%, p = 0.19), and bleeding (18.2% vs 9.5%, p = 0.66), respectively.

CONCLUSION

Among patients receiving VA-ECMO-supported RRT, our study revealed comparable in-hospital mortality rates between CRRT and PD, although PD was associated with a higher incidence of catheter-related complications.

摘要

简介

在接受静脉-动脉体外膜肺氧合（VA-ECMO）治疗的患者中，肾脏替代治疗（RRT）的最佳模式仍不清楚。本研究旨在比较连续性肾脏替代治疗（CRRT）和腹膜透析（PD）在 VA-ECMO 患者中的疗效。

方法

本单中心回顾性研究纳入了发生急性肾损伤（AKI）并随后需要接受 CRRT 或 PD 的 VA-ECMO 患者。收集患者的人口统计学、合并症、临床特征、RRT 方式和结局等数据。主要结局是院内死亡率，次要结局包括住院时间、RRT 持续时间和与 RRT 相关的并发症。

结果

共纳入 43 例患者（72.1%为男性，平均年龄 58.2±15.7 岁）。其中 21 例患者在 ECMO 治疗期间接受 CRRT，22 例患者接受 PD。CRRT 和 PD 组的院内死亡率无显著差异（80.9% vs. 90.9%，p=0.35）。然而，PD 组与导管相关并发症的发生率较高，包括导管错位（31.8% vs. 4.7%，p=0.046）、感染（22.7% vs. 4.7%，p=0.19）和出血（18.2% vs. 9.5%，p=0.66）。