Fluid overload at initiation of renal replacement therapy is associated with lack of renal recovery in patients with acute kidney injury
Fluid overload at initiation of renal replacement therapy is associated with lack of renal recovery in patients with acute kidney injury
复制标题
DOI：
10.1093/ndt/gfr470
复制
发表时间：
2012-03-01
影响因子：
6.1
通讯作者：
Ojo, Akinlolu O.
中科院分区：
文献类型：
--
作者：
Heung, Michael;Wolfgram, Dawn F.;Ojo, Akinlolu O.
背景。需要开始肾脏替代治疗（RRT）的急性肾损伤（AKI）患者具有较差的短期和长期预后，包括透析依赖的发展。目前，对于哪些因素可以预测这一人群的肾脏恢复，我们知之甚少。我们对170例因急性肾小管坏死而住院的成人AKI患者进行了单中心回顾性分析，这些患者需要在住院时开始RRT治疗。数据收集包括患者特征、实验室数据、住院过程细节和RRT开始时的液体过载程度。主要观察指标为肾功能恢复至独立透析。在RRT开始的1年内，35.9%（61/170）的患者达到肾脏恢复的主要终点。RRT持续时间的中位数（四分位数间距）为1.1（3-33）天，出院前康复的患者占83.6%（51/61）。与未康复的患者相比，康复患者在RRT开始时的液体过载明显减少（3.5%对9.3%,P = 0.004）。在多变量Cox比例风险回归分析中，透析开始时液体负荷百分比的上升仍然是肾脏恢复的显著负相关预测因子（风险比0.97,95%可信区间0.95-1.00,P = 0.024）。在AM患者中，RRT开始时较高程度的液体负荷预示着1年后肾脏恢复较差。需要临床试验来确定针对液体超载的干预措施是否可以改善患者和肾脏的预后。
Background. Patients with acute kidney injury (AKI) requiring initiation of renal replacement therapy (RRT) have poor short- and long-term outcomes, including the development of dialysis dependence. Currently, little is known about what factors may predict renal recovery in this population.Methods. We conducted a single-center, retrospective analysis of 170 hospitalized adult patients with AKI attributed to acute tubular necrosis who required inpatient initiation of RRT. Data collection included patient characteristics, laboratory data, details of hospital course and degree of fluid overload at RRT initiation. The primary outcome was recovery of renal function to dialysis independence.Results. Within 1 year of RRT initiation, 35.9% (61/170) of patients reached the primary end point of renal recovery. The median (interquartile range) duration of RRT was 1 I (3-33) days and 83.6% (51/61) recovered prior to hospital discharge. Recovering patients had significantly less fluid overload at the time of RRT initiation compared to non-recovering patients (3.5 versus 9.3%, P = 0.004). In multivariate Cox proportional hazard regression analysis, a rise in percent fluid overload at dialysis initiation remained a significant negative predictor of renal recovery (hazard ratio 0.97, 95% confidence interval 0.95-1.00, P = 0.024).Conclusions. In patients with AM, a higher degree of fluid overload at RRT initiation predicts worse renal recovery at 1 year. Clinical trials are needed to determine whether interventions targeting fluid overload may improve patient and renal outcomes.