Matarneh Ahmad, Sardar Sundus, Akkari Abdelrauof, Shaeffer Eric, Abdulbasit Muhammad, Miller Ronald, Verma Navin, Ghahramani Nasrollah
Department of Nephrology, Pennsylvania State Milton S Hershey Medical Center, USA.
Department of Biostatistics, Penn State College of Medicine, Pennsylvania State Milton S Hershey Medical Center, USA.
Ren Fail. 2025 Dec;47(1):2504015. doi: 10.1080/0886022X.2025.2504015. Epub 2025 May 21.
Renal replacement therapy (RRT) is vital for managing acute kidney injury (AKI), with continuous renal replacement therapy (CRRT) and intermittent hemodialysis (iHD) as primary modalities. CRRT is preferred for critically ill patients due to gradual fluid and solute removal, whereas iHD is used for stable patients. Outcomes among AKI patients requiring RRT vary widely, with some recovering kidney function while others progress to end-stage renal disease (ESRD). This study evaluates the risk of dialysis dependence and ESRD within 90 days among AKI patients receiving RRT.
Retrospective cohort study analyzed inpatient admissions from the MarketScan database (2005-2021) with an AKI diagnosis requiring RRT, identified using ICD-10 codes. Logistic regression compared CRRT and iHD groups, adjusting for age, sex, length of stay, and calendar year.
Compared to iHD, CRRT was associated with 67% lower odds of dialysis dependence at discharge (OR = 0.33; 95% CI: 0.28-0.39) and 80% lower odds at 90 days (OR = 0.20; 95% CI: 0.16-0.27). Patients receiving both iHD and CRRT had higher odds of dialysis dependence at discharge (OR = 1.41; 95% CI: 1.27-1.57) but 46% lower odds at 90 days (OR = 0.54; 95% CI: 0.45-0.64). CRRT also reduced the risk of ESRD within 90 days by 88% (OR = 0.12; 95% CI: 0.10-0.14).
Our study demonstrates that compared to iHD, CRRT is associated with a significantly lower risk of dialysis dependence and progression to ESRD in patients with AKI. CRRT may prevent further kidney injury and promote improved renal recovery.
肾脏替代治疗（RRT）对于急性肾损伤（AKI）的管理至关重要，连续性肾脏替代治疗（CRRT）和间歇性血液透析（iHD）是主要治疗方式。由于能逐渐清除液体和溶质，CRRT更适合危重症患者，而iHD用于病情稳定的患者。需要RRT的AKI患者的预后差异很大，一些患者肾功能恢复，而另一些患者进展为终末期肾病（ESRD）。本研究评估接受RRT的AKI患者在90天内出现透析依赖和ESRD的风险。
回顾性队列研究分析了MarketScan数据库（2005 - 2021年）中诊断为AKI且需要RRT的住院患者，通过ICD - 10编码进行识别。逻辑回归比较了CRRT组和iHD组，并对年龄、性别、住院时间和日历年进行了调整。
与iHD相比，CRRT出院时透析依赖的几率降低了67%（OR = 0.33；95%CI：0.28 - 0.39），90天时降低了80%（OR = 0.20；95%CI：0.16 - 0.27）。接受iHD和CRRT两种治疗的患者出院时透析依赖的几率更高（OR = 1.41；95%CI：1.27 - 1.57），但90天时降低了46%（OR = 0.54；95%CI：0.45 - 0.64）。CRRT还将90天内ESRD的风险降低了88%（OR = 0.12；95%CI：0.
