Yutaro Inoue, Ryota Inokuchi, Hidehiko Nakano, Yoshiki Masuda, Osamu Nishida, Kent Doi
{"title":"急性肾损伤持续肾替代治疗期间血液中尿酸的降低率：一项多中心回顾性观察研究。","authors":"Yutaro Inoue, Ryota Inokuchi, Hidehiko Nakano, Yoshiki Masuda, Osamu Nishida, Kent Doi","doi":"10.1159/000542329","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Continuous renal replacement therapy (CRRT) eliminates these small solutes with equal efficacy under the same conditions. However, variations in the reduction rates of these solutes observed in patients with CRRT are likely influenced by factors other than removal through CRRT. This study evaluated the reduction rates of these small solutes during CRRT and their possible association with mortality.</p><p><strong>Methods: </strong>This study used the data of limited patients registered in the CHANGE study, which is a large retrospective observational study on CRRT management across 18 Japanese ICUs. Reduction rates of three solutes in blood, calculated on the 1st and 2nd days, were compared in patients with acute kidney injury (AKI) treated by CRRT. The potential association between solute reduction rates and mortality during CRRT or within 7 days after the termination of CRRT was evaluated.</p><p><strong>Results: </strong>In total, 163 patients with AKI were included in the analysis. The reductuin rates of uric acid (UA) were significantly higher than those of urea and creatinine for the 1st and 2nd tests in the entire cohort. Receiver operating curve (ROC) analysis revealed that lower UA reduction rates were significantly associated with mortality during CRRT or within 7 days after CRRT termination (area under the ROC curve: 0.62 [95% confidence interval {CI} 0.52-0.71] for the 1st test and 0.63 [95%CI 0.54-0.72] for the 2nd test). After adjusting for age and SOFA score, a significant association was observed between lower UA reduction rates and hospital mortality for both tests.</p><p><strong>Conclusion: </strong>Among the small solutes, UA reduction rates in patients with AKI treated with CRRT were notably higher than those of creatinine and urea. Furthermore, the significant association between lower UA reduction rates and mortality suggests that UA reduction rate may serve as a valuable indicator of insufficient removal of uremic solutes by CRRT, although the decline in UA production must be taken into account.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":null,"pages":null},"PeriodicalIF":2.2000,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Reduction Rate of Uric Acid in Blood During Continuous Renal Replacement Therapy for Acute Kidney Injury: A Multicenter Retrospective Observational Study.\",\"authors\":\"Yutaro Inoue, Ryota Inokuchi, Hidehiko Nakano, Yoshiki Masuda, Osamu Nishida, Kent Doi\",\"doi\":\"10.1159/000542329\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Continuous renal replacement therapy (CRRT) eliminates these small solutes with equal efficacy under the same conditions. However, variations in the reduction rates of these solutes observed in patients with CRRT are likely influenced by factors other than removal through CRRT. This study evaluated the reduction rates of these small solutes during CRRT and their possible association with mortality.</p><p><strong>Methods: </strong>This study used the data of limited patients registered in the CHANGE study, which is a large retrospective observational study on CRRT management across 18 Japanese ICUs. Reduction rates of three solutes in blood, calculated on the 1st and 2nd days, were compared in patients with acute kidney injury (AKI) treated by CRRT. The potential association between solute reduction rates and mortality during CRRT or within 7 days after the termination of CRRT was evaluated.</p><p><strong>Results: </strong>In total, 163 patients with AKI were included in the analysis. The reductuin rates of uric acid (UA) were significantly higher than those of urea and creatinine for the 1st and 2nd tests in the entire cohort. Receiver operating curve (ROC) analysis revealed that lower UA reduction rates were significantly associated with mortality during CRRT or within 7 days after CRRT termination (area under the ROC curve: 0.62 [95% confidence interval {CI} 0.52-0.71] for the 1st test and 0.63 [95%CI 0.54-0.72] for the 2nd test). After adjusting for age and SOFA score, a significant association was observed between lower UA reduction rates and hospital mortality for both tests.</p><p><strong>Conclusion: </strong>Among the small solutes, UA reduction rates in patients with AKI treated with CRRT were notably higher than those of creatinine and urea. Furthermore, the significant association between lower UA reduction rates and mortality suggests that UA reduction rate may serve as a valuable indicator of insufficient removal of uremic solutes by CRRT, although the decline in UA production must be taken into account.</p>\",\"PeriodicalId\":8953,\"journal\":{\"name\":\"Blood Purification\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2024-10-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Blood Purification\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1159/000542329\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"HEMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Blood Purification","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000542329","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"HEMATOLOGY","Score":null,"Total":0}
Reduction Rate of Uric Acid in Blood During Continuous Renal Replacement Therapy for Acute Kidney Injury: A Multicenter Retrospective Observational Study.
Introduction: Continuous renal replacement therapy (CRRT) eliminates these small solutes with equal efficacy under the same conditions. However, variations in the reduction rates of these solutes observed in patients with CRRT are likely influenced by factors other than removal through CRRT. This study evaluated the reduction rates of these small solutes during CRRT and their possible association with mortality.
Methods: This study used the data of limited patients registered in the CHANGE study, which is a large retrospective observational study on CRRT management across 18 Japanese ICUs. Reduction rates of three solutes in blood, calculated on the 1st and 2nd days, were compared in patients with acute kidney injury (AKI) treated by CRRT. The potential association between solute reduction rates and mortality during CRRT or within 7 days after the termination of CRRT was evaluated.
Results: In total, 163 patients with AKI were included in the analysis. The reductuin rates of uric acid (UA) were significantly higher than those of urea and creatinine for the 1st and 2nd tests in the entire cohort. Receiver operating curve (ROC) analysis revealed that lower UA reduction rates were significantly associated with mortality during CRRT or within 7 days after CRRT termination (area under the ROC curve: 0.62 [95% confidence interval {CI} 0.52-0.71] for the 1st test and 0.63 [95%CI 0.54-0.72] for the 2nd test). After adjusting for age and SOFA score, a significant association was observed between lower UA reduction rates and hospital mortality for both tests.
Conclusion: Among the small solutes, UA reduction rates in patients with AKI treated with CRRT were notably higher than those of creatinine and urea. Furthermore, the significant association between lower UA reduction rates and mortality suggests that UA reduction rate may serve as a valuable indicator of insufficient removal of uremic solutes by CRRT, although the decline in UA production must be taken into account.
期刊介绍：
Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.
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