Effect of fluid overload and dose of replacement fluid on survival in hemofiltration
Effect of fluid overload and dose of replacement fluid on survival in hemofiltration
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DOI：
10.1007/s00467-004-1655-1
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发表时间：
2004-12-01
影响因子：
3
通讯作者：
Symons, JM
中科院分区：
文献类型：
--
作者：
Gillespie, RS;Seidel, K;Symons, JM
连续性肾脏替代治疗（CRRT）用于治疗儿童肾衰竭。尽管该技术被广泛使用，但很少有研究评估置换液剂量或开始时液体过载程度的变化与结局的关系。我们使用多变量考克斯回归模型对在我们机构接受对流CRRT治疗的患者进行了回顾性审查。CRRT启动时液体超负荷程度高（>10%）的儿童死亡风险是液体超负荷程度低或无液体超负荷儿童的3.02倍[95%置信区间（CI）1.50-6.10，P =0.002]。接受高剂量对流清除治疗的儿童死亡风险比无统计学显著性。我们的数据支持先前的研究结果，即容量超负荷超过10%与不良结局密切相关。我们倾向于在过度液体超负荷发生之前尽早进行CRRT。与成人的研究结果相反，我们发现较高的对流清除率没有优势。考虑到高容量血液滤过相关的风险和复杂性增加，我们建议在接受连续性静脉-静脉血液滤过治疗的儿童中广泛采用高水平对流之前进行进一步研究。
Continuous renal replacement therapy (CRRT) is used to treat renal failure in children. Despite widespread use of the technique, little research has evaluated how variations in dose of replacement fluid or degree of fluid overload at initiation relate to outcomes. We conducted a retrospective review of patients treated with convective CRRT at our institution, using a multivariable Cox regression model. Children with high fluid overload (>10%) at CRRT initiation were at 3.02 times greater risk of mortality than those with low or no fluid overload [95% confidence interval (CI) 1.50-6.10, P =0.002]. The hazard ratio for death in children treated with high-dose convective clearance was not statistically significant. Our data support previous findings that volume overload in excess of 10% is strongly correlated with poor outcome. We favor early institution of CRRT, before excessive fluid overload occurs. In contrast to findings in adults, we find no advantage to higher rates of convective clearance. Given the risks and increased complexity associated with high-volume hemofiltration, we recommend further study prior to widespread adoption of high-level convection in children treated with continuous veno-venous hemofiltration.