Association between diuretics and successful discontinuation of continuous renal replacement therapy in critically ill patients with acute kidney injury.
Association between diuretics and successful discontinuation of continuous renal replacement therapy in critically ill patients with acute kidney injury.
复制标题
DOI：
10.1186/s13054-018-2192-9
复制
发表时间：
2018-10-10
期刊：
影响因子：
--
通讯作者：
Jang HR
中科院分区：
文献类型：
--
作者：
Jeon J;Kim DH;Baeg SI;Lee EJ;Chung CR;Jeon K;Lee JE;Huh W;Suh GY;Kim YG;Kim DJ;Oh HY;Jang HR
尽管在急性肾损伤（阿基）危重患者中积极应用连续性肾脏替代治疗（CRRT），但在尝试停止CRRT时，对利尿剂治疗尚无共识。评价了利尿剂对危重患者中止CRRT的影响。这项回顾性队列研究入组了2009年至2014年期间1176例停止CRRT后存活3天以上的成人患者。根据在停止CRRT或使用利尿剂后3天内重新开始肾脏替代治疗对患者进行分类。终止CRRT后尿量（UO）和肾功能的变化是结局。还分析了成功中止CRRT的预测因素。CRRT停药组的CRRT持续时间较短，停药后利尿剂的使用频率较高，停药前一天[第-1天（第-1天）]的UO较大。停止CRRT后，利尿剂组的UO和血清肌酐升高幅度更大。在CRRT中止组中，持续输注呋塞米倾向于更有效地增加UO。多变量回归分析确定第1天高UO和使用利尿剂是成功中止CRRT的重要预测因素。第-1天UO 125 mL/天是预测CRRT后接受利尿剂治疗的少尿患者成功中止CRRT的临界值。第-1天UO和积极的利尿剂治疗与成功的CRRT停药相关。在阿基重症患者中尝试CRRT停药时，利尿剂治疗可能会有帮助，因为它可以诱导良好的液体平衡，尤其是在少尿患者中。
Despite aggressive application of continuous renal replacement therapy (CRRT) in critically ill patients with acute kidney injury (AKI), there is no consensus on diuretic therapy when discontinuation of CRRT is attempted. The effect of diuretics on discontinuation of CRRT in critically ill patients was evaluated. This retrospective cohort study enrolled 1176 adult patients who survived for more than 3 days after discontinuing CRRT between 2009 and 2014. Patients were categorized depending on the re-initiation of renal replacement therapy within 3 days after discontinuing CRRT or use of diuretics. Changes in urine output (UO) and renal function after discontinuing CRRT were outcomes. Predictive factors for successful discontinuation of CRRT were also analyzed. The CRRT discontinuation group had a shorter duration of CRRT, more frequent use of diuretics after discontinuing CRRT, and greater UO on the day before CRRT discontinuation [day minus 1 (day − 1)]. The diuretics group had greater increases in UO and serum creatinine elevation after discontinuing CRRT. In the CRRT discontinuation group, continuous infusion of furosemide tended to increase UO more effectively. Multivariable regression analysis identified high day − 1 UO and use of diuretics as significant predictors of successful discontinuation of CRRT. Day − 1 UO of 125 mL/day was the cutoff value for predicting successful discontinuation of CRRT in oliguric patients treated with diuretics following CRRT. Day − 1 UO and aggressive diuretic therapy were associated with successful CRRT discontinuation. Diuretic therapy may be helpful when attempting CRRT discontinuation in critically ill patients with AKI, by inducing a favorable fluid balance, especially in oliguric patients.
登录
查看更多内容
影响因子：
19.6
作者：
Bouchard, Josee;Soroko, Sharon B.;Mehta, Ravindra L.
通讯作者：
Mehta, Ravindra L.
影响因子：
3
作者：
Andrikos, Emilios;Tseke, Paraskevi;Ronco, Claudio
通讯作者：
Ronco, Claudio
影响因子：
8.8
作者：
Metnitz, PGH;Krenn, CG;Druml, W
通讯作者：
Druml, W
影响因子：
13.6
作者：
Koyner, Jay L.;Davison, Danielle L.;Chawla, Lakhmir S.
通讯作者：
Chawla, Lakhmir S.
影响因子：
4.5
作者：
MASON, J;KAIN, H;SCHNERMANN, J
通讯作者：
SCHNERMANN, J