Patient and kidney survival by dialysis modality in critically ill patients with acute kidney injury
Patient and kidney survival by dialysis modality in critically ill patients with acute kidney injury
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DOI：
10.1177/039139880703000402
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发表时间：
2007-04-01
影响因子：
1.7
通讯作者：
Ronco, C.
中科院分区：
文献类型：
--
作者：
Uchino, S.;Bellomo, R.;Ronco, C.
通过一个大型的国际队列，我们试图确定肾脏替代治疗(RRT)的初始技术对重症监护病房(ICU)急性肾功能衰竭(ARF)结局的影响。我们在23个国家的54个ICU招募了1218名接受持续RRT(CRRT)或间歇RRT(IRRT)治疗的ARF患者。我们获得了人口统计学、生化和临床数据，并跟踪观察了患者的死亡或出院情况。分析信息以评估治疗选择对存活率和肾脏恢复的独立影响。首次接受CRRT的患者(N=1006，82.6%)比接受IRRT的患者(N=212，17.40%)更频繁地需要血管升压药和机械通气(P<；0.0001)。未调整的住院存活率较低(35.8%vs.51.9%，p<；0.0001)。然而，在CRRT后，出院时未经调整的透析独立性更高(85.5%比66.2%，p<；0.0001)。多因素Logistic回归分析显示，CPPT的选择不是住院生存或非透析住院生存的独立预测因素。然而，选择CRRT是幸存者出院时透析独立性的预测因素(OR：3.333，95%CI：1.845-6.024，p<；0.0001)。使用倾向评分进行进一步调整并没有显著改变这些结果。我们的结论是，在世界范围内，选择CRRT作为初始治疗并不是住院生存或非透析住院生存的预测因素，而是幸存者肾脏恢复的独立预测因素。
Using a large, international cohort, we sought to determine the effect of initial technique of renal replacement therapy (RRT) on the outcome of acute renal failure (ARF) in the intensive care unit (ICU). We enrolled 1218 patients treated with continuous RRT (CRRT) or intermittent RRT (IRRT) for ARF in 54 ICUs in 23 countries. We obtained demographic, biochemical and clinical data and followed patients to either death or hospital discharge. Information was analyzed to assess the independent impact of treatment choice on survival and renal recovery. Patients treated first with CRRT (N=1006, 82.6%) required vasopressor drugs and mechanical ventilation more frequently compared to those receiving IRRT (N=212, 17.40%), (p < 0.0001). Unadjusted hospital survival was lower (35.8% vs. 51.9%, p < 0.0001). However, unadjusted dialysis-independence at hospital discharge was higher after CRRT (85.5% vs. 66.2%, p < 0.0001). Multivariable logistic regression showed that choice of CPPT was not an independent predictor of hospital survival or dialysis-free hospital survival. However, the choice of CRRT was a predictor of dialysis independence at hospital discharge among survivors (OR: 3.333, 95% Cl: 1.845 - 6.024, p < 0.0001). Further adjustment using a propensity score did not significantly change these results. We conclude that worldwide, the choice of CRRT as initial therapy is not a predictor of hospital survival or dialysis-free hospital survival but is an independent predictor of renal recovery among survivors.