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接受持续肾脏替代治疗的重症监护病房患者的病情转变及长期临床结局

Transitions and Long-Term Clinical Outcomes in Patients Admitted in Intensive Care Units Receiving Continuous Renal Replacement Therapy.

作者信息

Valdenebro María, Portoles Jose, Serrano Salazar María Luisa, Muñoz Sánchez Ana, Alameda-Aguado Ines, Martín Rodriguez Leyre, Zalamea-Jarrin Felipe, López-Sánchez Paula

机构信息

Nephrology Department, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, 28222 Majadahonda, Spain.

Medicine Department, Universidad Autónoma de Madrid, 28049 Madrid, Spain.

出版信息

J Clin Med. 2024 Aug 27;13(17):5085. doi: 10.3390/jcm13175085.

DOI:10.3390/jcm13175085
PMID:39274298
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11396298/
Abstract

: Acute kidney injury (AKI) significantly disrupts vital renal functions and is a common and serious condition in intensive care units (ICUs). AKI leads to extended hospital stays, increases mortality rates, and often necessitates nephrology consultations. Continuous renal replacement therapy (CRRT) plays a central role in managing AKI, requiring a multidisciplinary approach involving nephrologists, intensivists, and anesthesiologists. This study examines the clinical profile and progression of AKI in ICU patients requiring CRRT, with a focus on CRRT indications and modalities. : We conducted a single-center retrospective observational study on ICU patients with AKI requiring CRRT from January to December 2019. AKI diagnosis followed the RIFLE criteria, and patients who received CRRT for less than 36 h were excluded. Data collected included demographics, hemodynamic parameters, and renal function parameters, with follow-ups at 1 week, 1 month, 6 months, and 12 months. Statistical analyses evaluated outcomes and transitions between CRRT and other renal replacement therapies. : Among 123 evaluated patients, 95 met inclusion criteria. Fifteen patients received CRRT for less than 36 h, with an early mortality rate of 80%. The final cohort comprised 80 patients who underwent CRRT for over 36 h, with a mean age of 65.3 years (SD = 13.6) and a Charlson index of 6.4. Patients were categorized based on primary diagnosis into heart failure, cardiac surgery, sepsis, other surgeries, and miscellanea groups. Mortality rates were highest in the heart failure and miscellanea groups. Significant variability was observed in therapy transitions and long-term outcomes. Continuous venovenous hemodiafiltration (CVVHDF) was the most frequently used CRRT modality. : This study highlights the variability in CRRT practices and the poor prognosis for critically ill patients with AKI requiring CRRT. Timely nephrology consultation and tailored treatment plans may improve patient outcomes and optimize CRRT utilization. Future research should focus on refining CRRT protocols and exploring preventive strategies for AKI.

摘要

急性肾损伤(AKI)严重扰乱重要的肾功能,是重症监护病房(ICU)中常见且严重的病症。AKI导致住院时间延长,死亡率增加,并且常常需要肾内科会诊。连续性肾脏替代治疗(CRRT)在AKI的管理中起着核心作用,需要肾病科医生、重症监护医生和麻醉医生参与的多学科方法。本研究调查了需要CRRT的ICU患者中AKI的临床特征和病程,重点关注CRRT的适应症和模式。

我们对2019年1月至12月需要CRRT的ICU-AKI患者进行了单中心回顾性观察研究。AKI诊断遵循RIFLE标准,接受CRRT少于36小时的患者被排除。收集的数据包括人口统计学、血流动力学参数和肾功能参数,并在1周、1个月、6个月和1年进行随访。统计分析评估了CRRT与其他肾脏替代治疗之间的结果和转换。

在123例评估患者中,95例符合纳入标准。15例患者接受CRRT少于36小时,早期死亡率为80%。最终队列包括80例接受CRRT超过36小时的患者,平均年龄为65.3岁(标准差=13.6),Charlson指数为6.4。患者根据主要诊断分为心力衰竭、心脏手术、脓毒症、其他手术和杂项组。心力衰竭和杂项组的死亡率最高。在治疗转换和长期结果方面观察到显著差异。连续性静脉-静脉血液透析滤过(CVVHDF)是最常用的CRRT模式。

本研究强调了CRRT实践的变异性以及需要CRRT的AKI危重症患者的预后不良。及时的肾内科会诊和量身定制的治疗方案可能会改善患者的预后并优化CRRT的使用。未来的研究应专注于完善CRRT方案并探索AKI的预防策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d838/11396298/9ccf34d755be/jcm-13-05085-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d838/11396298/b4b58350222b/jcm-13-05085-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d838/11396298/898826b104ef/jcm-13-05085-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d838/11396298/9ccf34d755be/jcm-13-05085-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d838/11396298/b4b58350222b/jcm-13-05085-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d838/11396298/898826b104ef/jcm-13-05085-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d838/11396298/9ccf34d755be/jcm-13-05085-g003.jpg

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本文引用的文献

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Renal replacement therapy in critically ill patients with acute kidney injury: 2020 nephrologist's perspective.危重症急性肾损伤患者的肾脏替代治疗:2020年肾脏科医生的观点
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