ICU腎臟替代療法的應用以及出院時腎臟恢復情況
【Critical Care Med】---ICU腎臟替代療法的應用以及出院時腎臟恢復情況
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Objectives:Acute kidney injury requiring renal replacement therapy is a major concern in ICUs. Initial renal replacement therapy modality, continuous renal replacement therapy or intermittent hemodialysis, may impact renal recovery. The aim of this study was to assess the influence of initial renal replacement therapy modality on renal recovery at hospital discharge.
目標：需行腎臟替代治療的急性腎損傷是ICU的一個主要問題。初始腎臟替代治療方式，連續腎臟替代治療或間歇性血液透析可能影響腎臟的恢復。本研究的目的是評估初次腎臟替代治療方式對出院時腎功能恢復的影響。
Design: Retrospective cohort study of all ICU stays from January 1, 2010, to December 31, 2013, with a 「renal replacement therapy for acute kidney injury」 code using the French hospital discharge database.
設計：應用法國醫院出院資料庫對2010年1月1日至2013年12月31日期間所有ICU住院患者進行的回顧性隊列研究，檢索關鍵詞「急性腎損傷行腎臟替代治療」。
Setting: Two hundred ninety-one ICUs in France.?Patients: A total of 1,031,120 stays: 58,635 with renal replacement therapy for acute kidney injury and 25,750 included in the main analysis.?Interventions: None.?Measurements Main Results: PPatients alive at hospital dis- charge were grouped according to initial modality (continuous renal replacement therapy or intermittent hemodialysis) and included in the main analysis to identify predictors of renal recovery. Renal recovery was defined as greater than 3 days without renal replacement therapy before hospital discharge. The main analysis was a hierarchical logistic regression analysis including patient demographics, comorbidities, and severity variables, as well as center characteristics. Three sensitivity analyses were performed. Overall mortality was 56.1%, and overall renal recovery was 86.2%. Intermittent hemodialysis was associated with a lower likelihood of recovery at hospital discharge; odds ratio, 0.910 (95% CI, 0.834–0.992) p value equals to 0.0327. Results were consistent across all sensitivity analyses with odds/hazards ratios ranging from 0.883 to 0.958.
地點：法國的219個ICU。患者：總住院次數共計1031120次，58635例急性腎損傷行腎替代治療，主要分析了其中25750例。干預措施：無。測量及主要結果：根據初始治療模式（連續性腎臟替代治療或間斷血液透析）對出院時存活的患者進行分組，並包含主要分析以確定腎臟恢復預測因子。腎臟恢復的定義為在出院前有3天以上無需腎臟替代治療。主要分析是基於對患者人口學統計、併發症、病情嚴重度以及主要病情特點進行的分層邏輯回歸分析。進行了三次靈敏度分析。總死亡率為56.1％，總腎臟恢復率為86.2％。間斷血液透析與出院時較低腎臟恢復率有關：比值比，0.910（95％CI，0.834-0.992），p =0.0327。結果於所有敏感性分析中均一致，比值/風險比率範圍為0.883-0.958。
Conclusions: In this large retrospective study, intermittent hemodialysis as an initial modality was associated with lower renal recovery at hospital discharge among patients with acute kidney injury, although the difference seems somewhat clinically limited. (Crit Care Med 2017; XX:00–00)
結論：在這項大型回顧性研究中，間斷血液透析作為急性腎損傷的初始治療方式與此類患者出院時較低的腎功能恢復相關，儘管這種差異在臨床上似乎有所局限。 （Crit Care Med 2017; XX：00-00）
Key Words: acute kidney injury; continuous renal replacement therapy; intermittent hemodialysis; renal recovery; renal replacement therapy modality
關鍵詞：急性腎損傷;連續腎臟替代治療;間斷血液透析;腎臟恢復;腎替代療法
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