Shen Y N, Wu B Y, Liu K, Xu W, Xing C Y, Mao H J
Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing 210029, China.
Zhonghua Yi Xue Za Zhi. 2024 Nov 26;104(44):4057-4064. doi: 10.3760/cma.j.cn112137-20240406-00796.
To evaluate the association between early net ultrafiltration (NUF) rate and risk of death in patients with cardiac surgery-associated acute kidney injury (CSA-AKI) requiring continuous renal replacement therapy (CRRT). Adult patients who received CRRT for more than 24 hours due to CSA-AKI in the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2021 were prospectively included. The NUF rate during the first 48 hours of CRRT was taken as a classified variable (low rate:<1.70 ml·kg·h; moderate rate: 1.70-2.47 ml·kg·h; high rate:>2.47 ml·kg·h). The association between 90-day mortality and NUF rates was analyzed by Cox regression and mediation analyses. A total of 262 patients were enrolled (171 males and 91 females), with the median (, ) age of 64 (54, 71) years and median (, ) NUF rate of 2.03 (1.58, 2.62) ml·kg·h. The 90-day mortality was 60.3% (158/262). Compared with the moderate NUF rate, patients with the low NUF rate (adjusted =1.52, 95%: 1.01-2.27, =0.043) and high NUF rate (adjusted =1.54, 95%: 1.02-2.33, =0.039) had a significantly higher risk of 90-day death. In mediation analysis, compared with the moderate NUF rate, the putative effect of the high NUF rate on 90-day mortality was direct [adjusted average direct effects (ADE)=1.12, 95%: 1.04-1.21,=0.004] and not mediated by effects of the NUF rate on fluid balance [adjusted average causal mediation effects (ACME)=1.00, 95%:0.98-1.01, =0.502]. The putative effect of the low NUF rate on mortality was not direct (adjusted ADE=0.93, 95%:0.81-1.05, =0.274), but was mediated by its effect on fluid balance (adjusted ACME=0.93, 95%:0.87-0.98, =0.018). Compared with NUF rates between 1.70-2.47 ml·kg·h within the first 48 hour of CRRT, NUF rates>2.47 and<1.70 ml·kg·h were associated with higher mortality in CSA-AKI patients receiving CRRT.
评估心脏手术相关急性肾损伤（CSA-AKI）且需要持续肾脏替代治疗（CRRT）的患者早期净超滤（NUF）率与死亡风险之间的关联。前瞻性纳入了2016年1月至2021年12月在南京医科大学第一附属医院因CSA-AKI接受CRRT超过24小时的成年患者。将CRRT开始后48小时内的NUF率作为分类变量（低速率：<1.70 ml·kg·h；中速率：1.70 - 2.47 ml·kg·h；高速率：>2.47 ml·kg·h）。通过Cox回归和中介分析来分析90天死亡率与NUF率之间的关联。共纳入262例患者（男性171例，女性91例），年龄中位数（四分位间距）为64（54，71）岁，NUF率中位数（四分位间距）为2.03（1.58，2.62）ml·kg·h。90天死亡率为60.3%（158/262）。与中NUF率相比，低NUF率（校正后HR = 1.52，95%CI：1.01 - 2.27，P = 0.043）和高NUF率（校正后HR = 1.54，95%CI：1.02 - 2.33，P = 0.039）的患者90天死亡风险显著更高。在中介分析中，与中NUF率相比，高NUF率对90天死亡率的假定效应是直接的[校正平均直接效应（ADE）= 1.12，95%CI：1.
