Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury
Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury
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DOI：
10.1016/j.jcrc.2007.12.017
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发表时间：
2009-03-01
影响因子：
3.7
通讯作者：
Kellum, John A.
中科院分区：
文献类型：
--
作者：
Bagshaw, Sean M.;Uchino, Shigehiko;Kellum, John A.
目的：本研究的目的是评估严重急性肾损伤的肾脏替代治疗 (RRT) 时机与临床结果之间的关系。方法：这是一项前瞻性多中心观察性研究，在 23 个国家的 54 个重症监护病房 (ICU) 中进行，招募了 1238 名患者。结果：RRT 时机根据尿素中值和肌酐中位数分为“早期”和“晚期” RRT 开始的时间。时间也按时间分类，从入住 ICU 到早期（5 天）。根据血清尿素确定的肾脏替代治疗时机显示，粗死亡率（尿素 24.2 mmol/L 为 63.4%；比值比 [OR]，0.92；95% 置信区间 [CI]，0.73-1.15；P = .48）或协变量调整死亡率（OR，1.25；95% CI，0.91-1.70；P = .16）。当按肌酐分层时，晚期 RRT 与较低的粗值相关（肌酐>309 μmol/L 为 53.4%，肌酐>309 μmol/L 为 71.4%
Purpose: The aim of this study is to evaluate the relationship between timing of renal replacement therapy (RRT) in severe acute kidney injury and clinical outcomes.Methods: This was a prospective multicenter observational study conducted at 54 intensive care units (ICUs) in 23 countries enrolling 1238 patients.Results: Timing of RRT was stratified into "early" and "late" by median urea and creatinine at the time RRT was started. Timing was also categorized temporally from ICU admission into early (5 days). Renal replacement therapy timing by serum urea showed no significant difference in crude (63.4% for urea 24.2 mmol/L; odds ratio [OR], 0.92; 95% confidence interval [CI], 0.73-1.15; P = .48) or covariate-adjusted mortality (OR, 1.25; 95% CI, 0.91-1.70; P = .16). When stratified by creatinine, late RRT was associated with lower crude (53.4% for creatinine >309 mu mol/L vs 71.4% for creatinine