The Association Between Renal Replacement Therapy Modality and Long-Term Outcomes Among Critically Ill Adults With Acute Kidney Injury: A Retrospective Cohort Study
The Association Between Renal Replacement Therapy Modality and Long-Term Outcomes Among Critically Ill Adults With Acute Kidney Injury: A Retrospective Cohort Study
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DOI：
10.1097/ccm.0000000000000042
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发表时间：
2014-04-01
影响因子：
8.8
通讯作者：
Ray, Joel G.
中科院分区：
文献类型：
--
作者：
Wald, Ron;Shariff, Salimah Z.;Ray, Joel G.
目的：在急性肾损伤的危重患者中，肾脏替代治疗方式对长期肾功能的影响尚不清楚。与传统的间歇性血液透析相比，连续性肾脏替代治疗可通过提供更大的血流动力学稳定性来促进肾脏恢复;但连续性肾脏替代治疗可能不会提高患者生存率，并且资源密集。我们的目的是确定连续性肾脏替代治疗是否与慢性透析的风险较低相比，间歇性血液透析，急性肾损伤的幸存者。设计：回顾性队列研究。设置：链接的人口范围内的管理数据库在安大略，加拿大。患者：危重病成人谁开始透析急性肾损伤1996年7月至2009年12月。在主要分析中，我们认为那些谁生存到至少90天后，肾脏替代治疗initiation.Interventions：首次接受连续性肾脏替代治疗与间歇性hemodialys. Measures和主要结果：连续性肾脏替代治疗收件人匹配1：1间歇性血液透析收件人的基础上，慢性肾脏疾病的历史，接受机械通气，并接受连续性肾脏替代治疗的可能性的倾向评分。使用考克斯比例风险评价初始肾脏替代治疗方式与慢性透析主要结局（定义为需要连续90天透析）之间的关系。我们确定了2，315名连续性肾脏替代治疗接受者，其中2，004名（87%）与2，004名间歇性血液透析接受者成功匹配。参与者的随访时间中位数为3年。与间歇性血液透析相比，最初接受连续性肾脏替代治疗的患者的慢性透析风险显著降低（风险比，0.75; 95% CI，0.65-0.87）。这种关系是更突出的那些既存慢性肾脏疾病（P值为交互作用项= 0.065）和心力衰竭（P值为交互作用项= 0.035）。结论：与间歇性血液透析相比，连续性肾脏替代治疗的急性肾损伤的危重成人开始与慢性透析的可能性较低。
Objective: Among critically ill patients with acute kidney injury, the impact of renal replacement therapy modality on long-term kidney function is unknown. Compared with conventional intermittent hemodialysis, continuous renal replacement therapy may promote kidney recovery by conferring greater hemodynamic stability; yet continuous renal replacement therapy may not enhance patient survival and is resource intense. Our objective was to determine whether continuous renal replacement therapy was associated with a lower risk of chronic dialysis as compared with intermittent hemodialysis, among survivors of acute kidney injury.Design: Retrospective cohort study.Setting: Linked population-wide administrative databases in Ontario, Canada.Patients: Critically ill adults who initiated dialysis for acute kidney injury between July 1996 and December 2009. In the primary analysis, we considered those who survived to at least 90 days after renal replacement therapy initiation.Interventions: Initial receipt of continuous renal replacement therapy versus intermittent hemodialysis.Measurements and Main Results: Continuous renal replacement therapy recipients were matched 1:1 to intermittent hemodialysis recipients based on a history of chronic kidney disease, receipt of mechanical ventilation, and a propensity score for the likelihood of receiving continuous renal replacement therapy. Cox proportional hazards were used to evaluate the relationship between initial renal replacement therapy modality and the primary outcome of chronic dialysis, defined as the need for dialysis for a consecutive period of 90 days. We identified 2,315 continuous renal replacement therapy recipients of whom 2,004 (87%) were successfully matched to 2,004 intermittent hemodialysis recipients. Participants were followed over a median duration of 3 years. The risk of chronic dialysis was significantly lower among patients who initially received continuous renal replacement therapy versus intermittent hemodialysis (hazard ratio, 0.75; 95% CI, 0.65-0.87). This relation was more prominent among those with preexisting chronic kidney disease (p value for interaction term = 0.065) and heart failure (p value for interaction term = 0.035).Conclusions: Compared with intermittent hemodialysis, initiation of continuous renal replacement therapy in critically ill adults with acute kidney injury is associated with a lower likelihood of chronic dialysis.