确定体外膜氧合治疗危重患者肾脏替代治疗起始的最佳时机

IF 0.2 Q4 UROLOGY & NEPHROLOGY
Ussanee Boonsrirat, Chokethawee Ouejiaraphant, Atthaphong Phongphithakchai
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引用次数: 0

摘要

简介:急性肾损伤(AKI)是体外膜肺氧合(ECMO)治疗严重心肺功能不全患者最常见的并发症之一。尽管肾替代疗法(RRT)是AKI的标准治疗方法,但RRT的开始时间仍存在争议。目的:本研究旨在确定接受ECMO治疗的患者开始RRT的最佳时机。患者和方法:我们对2014年3月至2019年12月在一家三级医院中心的40名患者进行了回顾性队列研究。根据RRT开始的时间将患者分为两组,即ECMO治疗后的早期RRT(72小时内)或晚期RRT。主要结果为60天死亡率。次要结果是这些患者的生存预测因素。结果:两组60天死亡率无显著差异(早期RRT为76.9%,晚期为88.9%;P=0.031)。生存预测因素为ECMO启动72小时内RRT启动(HR:0.067,95%,CI:0.0010-0.457)、年龄≥60岁(HR:6.334,95%CI:1.268-31.625)、ECMO第7天液体平衡(HR:1.093,95%CI:1.007-1.187),eGFR-EPI≥60mL/min/1.73m2(HR:0.970,95%CI:0.946-0.996)。结论:在ECMO和RRT患者中,ECMO启动后72小时内的早期RRT与降低死亡风险显著相关。我们的研究结果表明,早期RRT对接受ECMO治疗的危重患者有生存益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Identifying the optimal timing of renal replacement therapy initiation among critically ill patients on extracorporeal membrane oxygenation therapy
Introduction: Acute kidney injury (AKI) is one of the most frequent complications in patients with severe cardiopulmonary dysfunction on extracorporeal membrane oxygenation (ECMO) therapy. Although renal replacement therapy (RRT) is the standard of care for AKI, the timing of initiation of RRT remains controversial. Objectives: This study aimed to determine the optimal timing of RRT initiation among patients receiving ECMO therapy. Patients and Methods: We conducted a retrospective cohort study of 40 patients in a tertiary hospital centre from March 2014 until December 2019. The patients were divided into two groups according to the timing of RRT initiation, i.e. early RRT (within 72 hours) or late RRT after ECMO treatment. The primary outcome was 60-day mortality. The secondary outcomes were survival predictors of these patients. Results: The 60-day mortality was not significantly different between the two groups (76.9% in the early RRT initiation and 88.9% in the late group; P=0.321). The predictors of survival were RRT start within 72 hours of ECMO initiation (HR: 0.067, 95%, CI: 0.010-0.457), age ≥ 60 years (HR: 6.334, 95% CI: 1.268-31.625), fluid balance on day seven of ECMO (HR: 1.093, 95% CI: 1.007-1.187), and eGFR-EPI ≥ 60 mL/min/1.73 m2 (HR: 0.970, 95% CI: 0.946-0.996). Conclusion: Among patients with ECMO and RRT, early RRT within 72 hours of ECMO initiation was significantly associated with a decreased risk of death. Our findings suggest the survival benefit of early RRT in critically ill patients treated with ECMO.
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来源期刊
Journal of Renal Injury Prevention
Journal of Renal Injury Prevention UROLOGY & NEPHROLOGY-
CiteScore
1.60
自引率
0.00%
发文量
36
期刊介绍: The Journal of Renal Injury Prevention (JRIP) is a quarterly peer-reviewed international journal devoted to the promotion of early diagnosis and prevention of renal diseases. It publishes in March, June, September and December of each year. It has pursued this aim through publishing editorials, original research articles, reviews, mini-reviews, commentaries, letters to the editor, hypothesis, case reports, epidemiology and prevention, news and views and renal biopsy teaching point. In this journal, particular emphasis is given to research, both experimental and clinical, aimed at protection/prevention of renal failure and modalities in the treatment of diabetic nephropathy. A further aim of this journal is to emphasize and strengthen the link between renal pathologists/nephropathologists and nephrologists. In addition, JRIP welcomes basic biomedical as well as pharmaceutical scientific research applied to clinical nephrology. Futuristic conceptual hypothesis that integrate various fields of acute kidney injury and renal tubular cell protection are encouraged to be submitted.
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