Door-to-dialysis time and daily hemodialysis in patients with leptospirosis: Impact on mortality
Door-to-dialysis time and daily hemodialysis in patients with leptospirosis: Impact on mortality
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DOI：
10.2215/cjn.00680207
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发表时间：
2007-07-01
影响因子：
9.8
通讯作者：
Seguro, Antonio C.
中科院分区：
文献类型：
--
作者：
Andrade, Lucia;Cleto, Sergio;Seguro, Antonio C.
背景：钩端螺旋体病是一个公共卫生问题，其严重形式（韦尔氏病）包括急性呼吸窘迫综合征，通常伴有急性肾损伤（AKI），并与高死亡率相关。最近的证据表明，透析剂量影响脓毒症所致AKI危重患者的预后。然而，这一人群在年龄、性别和伴随条件方面差异很大，因此很难确定适当的时机（透析上门时间）和透析剂量。设计、设置、参与者和测量：假设增加透析剂量可以最大限度地减少尿毒症并发症并改善这类患者的预后是合乎逻辑的。韦尔氏病患者构成了一个同质人群，通常没有合并症，因此提出了一个理想的模型来检验这一假设。结果：在该人群中评估透析剂量的影响，使用经典或缓慢的低效率血液透析，并比较两个时期/治疗方案：2002年至2003年/延迟，隔日透析（DAdD组，n = 15）和2004年至2005年/及时和每日透析（PaDD组，n = 18）。评估年龄、性别、AKI严重程度、APACHE评分、血清尿素和肾功能恢复时间。所有患者均接受血管活性药物治疗（因为血流动力学不稳定），并进行机械通气（因为急性呼吸窘迫综合征）。透析期间PaDD组平均血清尿素明显低于DAdD组。PaDD组患者死亡3例（16.7%），而DAdD组患者死亡10例（66.7%）。结论：基于本结果，认为Weil病危重患者不再适合隔日血液透析。
Background: Leptospirosis is a public health problem, the severe form of which (Weil's disease) includes acute respiratory distress syndrome, typically accompanied by acute kidney injury (AKI), and is associated with high mortality rates. Recent evidence suggests that dialysis dosage affects outcomes in critically ill patients with sepsis-induced AKI. However, this population varies widely in terms of age, gender, and concomitant conditions, making it difficult to determine the appropriate timing (door-to-dialysis time) and dialysis dosage.Design, setting, participants, and measurements: It is logical to assume that increasing the dialysis dosage would minimize uremic complications and improve outcomes in such patients. Patients with Weil's disease constitute a homogeneous population and are typically free of comorbidities, therefore presenting an ideal model in which to test this assumption.Results: The effects of dialysis dosage were evaluated in this population, with the use of either classic or slow low-efficiency hemodialysis, and two periods/treatment plans were compared: 2002 to 2003/delayed, alternate-day dialysis (DAdD group; n = 15) and 2004 to 2005/prompt and daily dialysis (PaDD group; n = 18). Age, gender, AKI severity, APACHE score, serum urea, and time to recovery of renal function were assessed. All patients received vasoactive drugs (because of hemodynamic instability) and were on mechanical ventilation (because of acute respiratory distress syndrome). Mean serum urea during the dialysis period was significantly lower in the PaDD group than in the DAdD group. Of the PaDD group patients, three (16.7%) died, compared with 10 (66.7%) of the DAdD group patients.Conclusions: On the basis of this result, it is believed that alternate-day hemodialysis is no longer appropriate for critically ill patients with Weil's disease.