Kim Jae Ho, Yoon Joonhee, Kim Ji-Eun, Jo Seongho, Lee Yuri, Kim Ji Won, Hwang Seun Deuk, Lee Seoung Woo, Song Joon Ho, Kim Kipyo
Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon, Republic of Korea.
Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon, Republic of Korea; Department of Nursing, College of Medicine, Inha University, Incheon, Republic of Korea.
J Crit Care. 2025 Feb;85:154944. doi: 10.1016/j.jcrc.2024.154944. Epub 2024 Oct 30.
Intermittent hemodialysis (IHD) is commonly implemented in patients with AKI-D, irrespective of the initial kidney replacement therapy (KRT) modality. However, concerns remain regarding the hemodynamic instability during IHD. This study aimed to assess the association between hypotensive episodes during IHD and kidney recovery in AKI-D patients.
We retrospectively enrolled AKI-D survivors who received IHD in the intensive care units of a tertiary care hospital in Korea from January 2018 to February 2024.
A total of 1791 IHD sessions from 209 AKI-D survivors were analyzed. The patients underwent a median of 7 IHD sessions (interquartile range [IQR] 3-11), with an incidence of intradialytic hypotension (IDH) of 16.8 % per patient. Of these, 43.1 % were dialysis-dependent at hospital discharge. The number of IDH was a significant predictor of dialysis dependence (odds ratio [OR] 1.56; 95 % confidence interval [CI] 1.16-2.22). Patients experiencing ≥3 IDH episodes had a substantially higher risk of dialysis dependence compared to those without IDH (OR 9.41; 95 % CI 2.41-41.69). In per-session analysis, the target ultrafiltration rate was identified as an independent risk factor for IDH occurrence.
Our study revealed that IHD-related hypotension during hospitalization has a cumulative negative impact on kidney recovery in AKI-D survivors.
无论初始肾脏替代治疗（KRT）方式如何，间歇性血液透析（IHD）常用于急性肾损伤-透析（AKI-D）患者。然而，对于IHD期间的血流动力学不稳定仍存在担忧。本研究旨在评估AKI-D患者IHD期间低血压发作与肾脏恢复之间的关联。
我们回顾性纳入了2018年1月至2024年2月在韩国一家三级医院重症监护病房接受IHD的AKI-D幸存者。
共分析了209例AKI-D幸存者的1791次IHD治疗。患者接受IHD治疗的中位数为7次（四分位间距[IQR]3 - 11次），每位患者透析期间低血压（IDH）的发生率为16.8%。其中，43.1%的患者在出院时依赖透析。IDH的次数是透析依赖的显著预测因素（比值比[OR]1.56；95%置信区间[CI]1.16 - 2.22）。与未发生IDH的患者相比，发生≥3次IDH发作的患者透析依赖风险显著更高（OR 9.41；95% CI 2.41 - 41.69）。在每次治疗分析中，目标超滤率被确定为IDH发生的独立危险因素。
我们的研究表明，住院期间与IHD相关的低血压对AKI-D幸存者的肾脏恢复有累积负面影响。
