脓毒症相关急性肾损伤间歇性与连续性肾脏替代治疗的比较：日本重症监护病房数据库的回顾性分析

Comparison of intermittent and continuous renal replacement therapy for sepsis-associated AKI: a retrospective analysis of the Japanese ICU database.

作者信息

Okano Hiromu, Okamoto Hiroshi, Tanaka Haruna, Sakurai Ryota, Yamazaki Tsutomu

机构信息

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.

出版信息

JA Clin Rep. 2025 Apr 28;11(1):24. doi: 10.1186/s40981-025-00787-8.

DOI:10.1186/s40981-025-00787-8

PMID:40293602

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12037946/

Abstract

INTRODUCTION

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

摘要

引言

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。

方法

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。

结果

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）。