Mayer Kirby P, Teixeira J Pedro, González-Seguel Felipe, Tran Vinh Q, Gross Jessica M, Horikawa-Strakovsky Arimitsu, Pal Chaitanya Anil, Shareef Zan T, Puffer Israel Hayley, Wen Yuan, Griffin Benjamin R, Neyra Javier A
Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, USA; Center for Muscle Biology, University of Kentucky, Lexington, KY, USA.
Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, NM, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.
J Crit Care. 2025 Oct;89:155142. doi: 10.1016/j.jcrc.2025.155142. Epub 2025 Jun 12.
Acute kidney injury (AKI) requiring continuous kidney replacement therapy (CKRT) has been hypothesized to increase the risk of developing intensive care unit-associated weakness (ICU-AW), but prospective data are lacking.
This prospective observational study evaluated critically ill adults with AKI requiring CKRT at two U.S. academic hospitals. Using ultrasonography (US), we quantified changes in rectus femoris (RF) muscle mass and quality in the first week after CKRT initiation. At hospital discharge, we assessed for ICU-AW, physical function, and frailty.
Twenty-three patients with median age 56 [IQR 47-60] years, BMI 29 [26-36] kg/m, and Charlson Comorbidity Index 3 [1.5-5] were enrolled. The baseline Sequential Organ Failure Assessment (SOFA) score was 9 [7.5-11.5] and CKRT duration was 4 [1-7] days. Six (26 %) patients died in the ICU and one (4 %) transitioned to comfort measures before study completion. Substantial muscle wasting occurred between Day 1 and Day 7: RF muscle thickness (mT) decreased by 10 % [3 %-20 %]; RF cross-sectional area (CSA) decreased by 19 % [12 %-22 %]; and echo intensity (EI) increased (implying worse muscle quality) by 14 % [5 %-25 %]. A significant effect of time within subjects was observed for all three ultrasound measures (CSA: F = 66.2, p < 0.001; mT: F = 27.1, p < 0.001; EI: F = 22.5, p < 0.001). At hospital discharge, 67 % of survivors (n = 10/15) met criteria for ICU-AW.
Patients with AKI requiring CKRT experienced significant muscle wasting in the first week following CKRT initiation and had high rate of ICU-AW at hospital discharge.
NCT05287204, Registered 20 October 2021.
需要持续肾脏替代治疗（CKRT）的急性肾损伤（AKI）被认为会增加发生重症监护病房相关性肌无力（ICU-AW）的风险，但缺乏前瞻性数据。
这项前瞻性观察性研究评估了美国两家学术医院中需要CKRT的AKI重症成年患者。我们使用超声（US）量化了CKRT开始后第一周股直肌（RF）肌肉质量和质量的变化。在出院时，我们评估了ICU-AW、身体功能和虚弱情况。
纳入了23例患者，中位年龄56[四分位间距47-60]岁，体重指数29[26-36]kg/m²，Charlson合并症指数3[1.5-5]。基线序贯器官衰竭评估（SOFA）评分9[7.5-11.5]，CKRT持续时间4[1-7]天。6例（26%）患者在重症监护病房死亡，1例（4%）在研究完成前转为姑息治疗。第1天至第7天出现了明显的肌肉萎缩：RF肌肉厚度（mT）下降了10%[3%-20%]；RF横截面积（CSA）下降了19%[12%-22%]；回声强度（EI）增加（意味着肌肉质量变差）14%[5%-25%]。对于所有三项超声测量指标，均观察到受试者内时间的显著影响（CSA：F=66.2，p<0.001；mT：F=27.1，p<0.001；EI：F=22.5，p<0.001）。出院时，67%的幸存者（n=10/15）符合ICU-AW标准。
需要CKRT的AKI患者在CKRT开始后的第一周出现了明显的肌肉萎缩，出院时ICU-AW发生率很高。
NCT05287204，2021年10月20日注册。
