Okano Hiromu, Okamoto Hiroshi, Tanaka Haruna, Sakurai Ryota, Yamazaki Tsutomu
Department of Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
Department of Social Medical Sciences, Graduate School of Medicine, International University of Health and Welfare, 4-1-26 Akasaka, Minato City, Tokyo, 107-8402, Japan.
JA Clin Rep. 2025 Apr 28;11(1):24. doi: 10.1186/s40981-025-00787-8.
While both intermittent renal replacement therapy (IRRT) and continuous renal replacement therapy (CRRT) are used to treat sepsis-associated acute kidney injury (S-AKI), their comparative effectiveness remains unclear. We compared the outcomes between these modalities in patients with S-AKI.
Data from the Japanese Intensive Care Patient Database (JIPAD) was used for this multi-center retrospective cohort study. Adult patients with S-AKI who received either IRRT or CRRT between 2015 and 2021 were included. The primary outcome was in-hospital mortality. We compared IRRT and CRRT using one-to-three propensity score matching analysis. A subgroup analysis was performed in patients with septic shock.
Of the 756 patients analyzed, 79 received IRRT, and 677 received CRRT. After propensity score matching, baseline characteristics were well-balanced between groups. In-hospital mortality showed no significant difference between IRRT and CRRT (48.6% vs. 38.0%; risk difference - 10.6%; 95% CI - 23.0 to 2.9; P = 0.11). In patients with septic shock, in-hospital mortality was also not different between groups (52.6% vs. 40.4%; risk difference - 12.2%; 95% CI - 28.8 to 3.7; P = 0.10).
IRRT and CRRT may be similar in-hospital mortality in patients with S-AKI. Further studies are warranted to determine the most effective renal replacement modality for this patient population.
虽然间歇性肾脏替代疗法（IRRT）和连续性肾脏替代疗法（CRRT）都用于治疗脓毒症相关性急性肾损伤（S-AKI），但其相对疗效仍不明确。我们比较了这些治疗方式在S-AKI患者中的结局。
本多中心回顾性队列研究使用了来自日本重症监护患者数据库（JIPAD）的数据。纳入了2015年至2021年间接受IRRT或CRRT的成年S-AKI患者。主要结局是住院死亡率。我们使用一对一至三对一的倾向评分匹配分析比较了IRRT和CRRT。对感染性休克患者进行了亚组分析。
在分析的756例患者中，79例接受了IRRT，677例接受了CRRT。倾向评分匹配后，两组间基线特征均衡。IRRT和CRRT的住院死亡率无显著差异（48.6%对38.0%；风险差-10.6%；95%CI-23.0至2.9；P=0.11）。在感染性休克患者中，两组间住院死亡率也无差异（52.6%对40.4%；风险差-12.2%；95%CI-28.8至3.7；P=0.10）。
对于S-AKI患者，IRRT和CRRT的住院死亡率可能相似。有必要进一步研究以确定针对该患者群体最有效的肾脏替代治疗方式。
