Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial
Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial
复制标题
DOI：
10.1016/s0140-6736(00)02430-2
复制
发表时间：
2000-07-01
期刊：
影响因子：
168.9
通讯作者：
La Greca, G
中科院分区：
文献类型：
--
作者：
Ronco, C;Bellomo, R;La Greca, G
背景连续性静脉-静脉血液滤过越来越多地用于治疗危重患者的急性肾功能衰竭，但对于适当的治疗剂量还没有建立一个明确的定义。我们进行了一项前瞻性随机研究，研究持续肾脏替代治疗中不同超滤剂量对存活率的影响。方法我们纳入了425例重症监护的急性肾功能衰竭患者，平均年龄61岁。将患者随机分为超滤量20mLh(-1)kg(-1)(组1,146例)、35mLh(-1)kg(-1组，139例)、45mLh(-1)kg(-1组，140例)。主要终点是停止血液滤过后15天的存活率。我们还评估了治疗期间肾功能的恢复情况和并发症的发生率。结果1组存活率明显低于2组(p=0.0007)和3组(p=0.0013)。第2组和第3组的存活率无显著差异(p=0.87)。对可能的混杂因素进行调整，并没有改变群体之间的差异模式。所有存活者在开始持续血液滤过前的血尿素氮浓度均低于死亡者。第1组、第2组和第3组分别有95%、92%和90%的幸存者肾功能完全恢复。所有组的并发症发生率都很低。这些危重患者的解释死亡率很高，但超滤率的增加显著提高了存活率。我们建议超滤应根据患者的体重而定，并应至少达到35mLh(-1)kg(-1)。
Background Continuous veno-venous haemofiltration is increasingly used to treat acute renal failure in critically ill patients, but a clear definition of an adequate treatment dose has not been established. We undertook a prospective randomised study of the impact different ultrafiltration doses in continuous renal replacement therapy on survival.Methods We enrolled 425 patients, with a mean age of 61 years, in intensive care who had acute renal failure. Patients were randomly assigned ultrafiltration at 20 mL h(-1) kg(-1) (group 1, n=146), 35 mL h(-1) kg(-1) (group 2, n=139), or 45 mL h(-1) kg(-1) (group 3, n=140). The primary endpoint was survival at 15 days after stopping haemofiltration. We also assessed recovery of renal function and frequency of complications during treatment. Analysis was by intention to treat.Results Survival in group 1 was;significantly lower than in groups 2 (p=0.0007) and 3 (p=0.0013). Survival in groups 2 and 3 did not differ significantly (p=0.87). Adjustment for possible confounding factors did not change the pattern of differences among the groups. Survivors in all groups had lower concentrations of blood urea nitrogen before continuous haemofiltration was started than non-survivors. 95%, 92%, and 90% of survivors in groups 1, 2, and 3, respectively, had full recovery of renal function. The frequency of complications was similarly low in all groups.Interpretation Mortality among these critically ill patients was high, but increase in the rate of ultrafiltration improved survival significantly. We recommend that ultrafiltration should be prescribed according to patient's bodyweight and should reach at least 35 mL h(-1) kg(-1).