Parapiboon Watanyu, Banjong Jakkrid, Siangtrong Chirakhana, Boonsayomphu Theerapun, Silakun Wirayut
Department of Medicine, Maharat Nakhonratchasima Hospital, Nakhon Ratchasima, Thailand.
Kidney Service Plan R 9 Commitee, The Ministry of Public Health, Nonthaburi, Thailand.
Blood Purif. 2025;54(1):9-17. doi: 10.1159/000542003. Epub 2024 Oct 14.
Intermittent hemodialysis (IHD) is a preferable renal replacement therapy (RRT) option in metformin-associated lactic acidosis (MALA) due to rapid correct metabolic acidosis. However, IHD might not be started immediately. Immediate urgent-start peritoneal dialysis (iUSPD) is used as a life-saving dialysis option and then followed by IHD. The outcomes of iUSPD were compared with other extracorporeal dialysis in MALA.
In two tertiary hospitals in Thailand, the outcomes of patients with MALA who had received three different RRT modalities (iUSPD followed by IHD, IHD, and continuous renal replacement therapy [CRRT]) from January 2015 to December 2019 were compared. The primary outcome was 30-day mortality. The secondary outcomes were door-to-dialysis time and 90-day RRT dependence.
A total of 180 MALA cases that required dialysis were included (20 iUSPD, 120 IHD, and 40 CRRT). Their mean age was 64 years. Most of the patients had severe metabolic acidosis (mean pH 6.91, HCO3 6 mmol/L, and anion gap 40 mmol/L) and were critically ill. The 30-day mortality was 30% in iUSPD, 9.2% in IHD, and 32.5% in CRRT (p = 0.001). The mortality risk in the iUSPD group was not significantly different from those of the IHD and CRRT groups (adjusted HR 2.5, 95% CI: 0.65-9.6, and adjusted HR 0.75, 95% CI: 0.2-2.78, respectively). All dialysis modalities had comparable 90-day dialysis dependence. iUSPD exhibited the shortest door-to-dialysis time.
In MALA, iUSPD followed by IHD might be a viable RRT option to save patient lives if no other dialysis options are available.
由于能快速纠正代谢性酸中毒，间歇性血液透析（IHD）是治疗二甲双胍相关乳酸酸中毒（MALA）时首选的肾脏替代治疗（RRT）方案。然而，IHD可能无法立即开始。紧急开始的腹膜透析（iUSPD）被用作挽救生命的透析选择，随后进行IHD。对iUSPD与MALA中其他体外透析的结果进行了比较。
在泰国的两家三级医院，比较了2015年1月至2019年12月期间接受三种不同RRT模式（iUSPD后接IHD、IHD和连续性肾脏替代治疗[CRRT]）的MALA患者的结果。主要结局是30天死亡率。次要结局是从入院到开始透析的时间和90天RRT依赖情况。
共纳入180例需要透析的MALA病例（20例iUSPD、120例IHD和40例CRRT）。他们的平均年龄为64岁。大多数患者患有严重代谢性酸中毒（平均pH值6.91、HCO3 6 mmol/L和阴离子间隙40 mmol/L）且病情危重。iUSPD组的30天死亡率为30%，IHD组为9.2%，CRRT组为32.5%（p = 0.001）。iUSPD组的死亡风险与IHD组和CRRT组相比无显著差异（调整后HR分别为2.5，95%CI：0.65 - 9.6；以及调整后HR为0.75，95%CI：0.2 - 2.78）。所有透析模式的90天透析依赖情况相当。iUSPD的入院到开始透析时间最短。
在MALA中，如果没有其他透析选择，iUSPD后接IHD可能是挽救患者生命的可行RRT选择。
