Inoue Yutaro, Inokuchi Ryota, Nakano Hidehiko, Masuda Yoshiki, Nishida Osamu, Doi Kent
Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan.
Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
Blood Purif. 2025;54(2):83-92. doi: 10.1159/000542329. Epub 2024 Oct 29.
Continuous renal replacement therapy (CRRT) eliminates these small solutes with equal efficacy under the same conditions. However, variations in the reduction rates of these solutes observed in patients with CRRT are likely influenced by factors other than removal through CRRT. This study evaluated the reduction rates of these small solutes during CRRT and their possible association with mortality.
This study used the data of limited patients registered in the CHANGE study, which is a large retrospective observational study on CRRT management across 18 Japanese ICUs. Reduction rates of three solutes in blood, calculated on the 1st and 2nd days, were compared in patients with acute kidney injury (AKI) treated by CRRT. The potential association between solute reduction rates and mortality during CRRT or within 7 days after the termination of CRRT was evaluated.
In total, 163 patients with AKI were included in the analysis. The reduction rates of uric acid (UA) were significantly higher than those of urea and creatinine for the 1st and 2nd tests in the entire cohort. Receiver operating characteristic (ROC) curve analysis revealed that lower UA reduction rates were significantly associated with mortality during CRRT or within 7 days after CRRT termination {area under the ROC curve: 0.62 [95% confidence interval (CI): 0.52-0.71] for the 1st test and 0.63 [95% CI: 0.54-0.72] for the 2nd test}. After adjusting for age and SOFA score, a significant association was observed between lower UA reduction rates and hospital mortality for both tests.
Among the small solutes, UA reduction rates in patients with AKI treated with CRRT were notably higher than those of creatinine and urea. Furthermore, the significant association between lower UA reduction rates and mortality suggests that UA reduction rate may serve as a valuable indicator of insufficient removal of uremic solutes by CRRT, although the decline in UA production must be taken into account.
Continuous renal replacement therapy (CRRT) eliminates these small solutes with equal efficacy under the same conditions. However, variations in the reduction rates of these solutes observed in patients with CRRT are likely influenced by factors other than removal through CRRT. This study evaluated the reduction rates of these small solutes during CRRT and their possible association with mortality.
This study used the data of limited patients registered in the CHANGE study, which is a large retrospective observational study on CRRT management across 18 Japanese ICUs. Reduction rates of three solutes in blood, calculated on the 1st and 2nd days, were compared in patients with acute kidney injury (AKI) treated by CRRT. The potential association between solute reduction rates and mortality during CRRT or within 7 days after the termination of CRRT was evaluated.
In total, 163 patients with AKI were included in the analysis. The reduction rates of uric acid (UA) were significantly higher than those of urea and creatinine for the 1st and 2nd tests in the entire cohort. Receiver operating characteristic (ROC) curve analysis revealed that lower UA reduction rates were significantly associated with mortality during CRRT or within 7 days after CRRT termination {area under the ROC curve: 0.62 [95% confidence interval (CI): 0.52-0.71] for the 1st test and 0.63 [95% CI: 0.54-0.72] for the 2nd test}. After adjusting for age and SOFA score, a significant association was observed between lower UA reduction rates and hospital mortality for both tests.
Among the small solutes, UA reduction rates in patients with AKI treated with CRRT were notably higher than those of creatinine and urea. Furthermore, the significant association between lower UA reduction rates and mortality suggests that UA reduction rate may serve as a valuable indicator of insufficient removal of uremic solutes by CRRT, although the decline in UA production must be taken into account.
连续性肾脏替代治疗（CRRT）在相同条件下能以相同疗效清除这些小分子溶质。然而，接受CRRT治疗的患者中观察到的这些溶质清除率的变化可能受到除CRRT清除之外的其他因素影响。本研究评估了CRRT期间这些小分子溶质的清除率及其与死亡率的可能关联。
本研究使用了CHANGE研究中登记的有限患者的数据，CHANGE研究是一项针对日本18个重症监护病房（ICU）的CRRT管理的大型回顾性观察研究。比较了接受CRRT治疗的急性肾损伤（AKI）患者第1天和第2天计算的血液中三种溶质的清除率。评估了溶质清除率与CRRT期间或CRRT结束后7天内死亡率之间的潜在关联。
总共163例AKI患者纳入分析。在整个队列中，第1次和第2次检测时尿酸（UA）的清除率显著高于尿素和肌酐。受试者工作特征（ROC）曲线分析显示，较低的UA清除率与CRRT期间或CRRT结束后7天内的死亡率显著相关{第1次检测时ROC曲线下面积：0.62[95%置信区间（CI）：0.52 - 0.71]，第2次检测时为0.63[95%CI：0.54 - 0.72]}。在调整年龄和序贯器官衰竭评估（SOFA）评分后，两次检测均观察到较低的UA清除率与医院死亡率之间存在显著关联。
在小分子溶质中，接受CRRT治疗的AKI患者的UA清除率显著高于肌酐和尿素。此外，较低的UA清除率与死亡率之间的显著关联表明，UA清除率可能是CRRT清除尿毒症溶质不足的一个有价值指标，尽管必须考虑UA生成的下降。
连续性肾脏替代治疗（CRRT）在相同条件下能以相同疗效清除这些小分子溶质。然而，接受CRRT治疗的患者中观察到的这些溶质清除率的变化可能受到除CRRT清除之外的其他因素影响。本研究评估了CRRT期间这些小分子溶质的清除率及其与死亡率的可能关联。
本研究使用了CHANGE研究中登记的有限患者的数据，CHANGE研究是一项针对日本18个重症监护病房（ICU）的CRRT管理的大型回顾性观察研究。比较了接受CRRT治疗的急性肾损伤（AKI）患者第1天和第2天计算的血液中三种溶质的清除率。评估了溶质清除率与CRRT期间或CRRT结束后7天内死亡率之间的潜在关联。
总共163例AKI患者纳入分析。在整个队列中，第1次和第2次检测时尿酸（UA）的清除率显著高于尿素和肌酐。受试者工作特征（ROC）曲线分析显示，较低的UA清除率与CRRT期间或CRRT结束后7天内的死亡率显著相关{第1次检测时ROC曲线下面积：0.62[95%置信区间（CI）：0.52 - 0.71]，第2次检测时为0.63[95%CI：0.54 - 0.72]}。在调整年龄和序贯器官衰竭评估（SOFA）评分后，两次检测均观察到较低的UA清除率与医院死亡率之间存在显著关联。
在小分子溶质中，接受CRRT治疗的AKI患者的UA清除率显著高于肌酐和尿素。此外，较低的UA清除率与死亡率之间的显著关联表明，UA清除率可能是CRRT清除尿毒症溶质不足的一个有价值指标，尽管必须考虑UA生成的下降。
