Intensity of renal support in critically ill patients with acute kidney injury
Intensity of renal support in critically ill patients with acute kidney injury
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DOI：
10.1056/nejmoa0802639
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发表时间：
2008-07-03
影响因子：
158.5
通讯作者：
Peduzzi, Peter
中科院分区：
文献类型：
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作者：
Palevsky, Paul M.;Zhang, Jane Hongyuan;Peduzzi, Peter
背景：急性肾损伤危重患者的最佳肾脏替代治疗强度存在争议。方法：我们将患有急性肾损伤且至少一种非肾器官衰竭或脓毒症的危重患者随机分配接受强化或低强度肾脏替代治疗。主要终点是第60天全因死亡。在两个研究组中，血流动力学稳定的患者接受间歇性血液透析，血流动力学不稳定的患者接受连续静脉静脉血液透析滤过或持续低效透析。接受强化治疗策略的患者接受间歇性血液透析和每周6次持续低效透析以及每小时每公斤体重35毫升的连续静脉静脉血液透析滤过；对于接受较低强度治疗策略的患者，相应的治疗每周三次，每次每公斤每小时20毫升。结果：两组1124例患者的基线特征相似。强化治疗组到第 60 天的全因死亡率为 53.6%，强度较低治疗组为 51.5%（比值比，1.09；95% 置信区间，0.86 至 1.40；P=0.47）。两组的肾脏替代治疗持续时间、肾功能或非肾器官衰竭的恢复率无显着差异。尽管两组中血液透析并发低血压的频率相似，但随机分配接受强化治疗的患者在间歇性透析期间发生低血压的情况较多。结论：与涉及规定剂量的较低强度治疗相比，急性肾损伤危重患者的强化肾脏支持并未降低死亡率、改善肾功能恢复或降低非肾器官衰竭发生率。 每周3次间歇性血液透析和每小时每公斤20毫升的连续肾脏替代治疗。 （ClinicalTrials.gov 编号，NCT00076219。）。
Background: The optimal intensity of renal-replacement therapy in critically ill patients with acute kidney injury is controversial.Methods: We randomly assigned critically ill patients with acute kidney injury and failure of at least one nonrenal organ or sepsis to receive intensive or less intensive renal-replacement therapy. The primary end point was death from any cause by day 60. In both study groups, hemodynamically stable patients underwent intermittent hemodialysis, and hemodynamically unstable patients underwent continuous venovenous hemodiafiltration or sustained low-efficiency dialysis. Patients receiving the intensive treatment strategy underwent intermittent hemodialysis and sustained low-efficiency dialysis six times per week and continuous venovenous hemodiafiltration at 35 ml per kilogram of body weight per hour; for patients receiving the less-intensive treatment strategy, the corresponding treatments were provided thrice weekly and at 20 ml per kilogram per hour.Results: Baseline characteristics of the 1124 patients in the two groups were similar. The rate of death from any cause by day 60 was 53.6% with intensive therapy and 51.5% with less-intensive therapy (odds ratio, 1.09; 95% confidence interval, 0.86 to 1.40; P=0.47). There was no significant difference between the two groups in the duration of renal-replacement therapy or the rate of recovery of kidney function or nonrenal organ failure. Hypotension during intermittent dialysis occurred in more patients randomly assigned to receive intensive therapy, although the frequency of hemodialysis sessions complicated by hypotension was similar in the two groups.Conclusions: Intensive renal support in critically ill patients with acute kidney injury did not decrease mortality, improve recovery of kidney function, or reduce the rate of nonrenal organ failure as compared with less-intensive therapy involving a defined dose of intermittent hemodialysis three times per week and continuous renal-replacement therapy at 20 ml per kilogram per hour. (ClinicalTrials.gov number, NCT00076219.).