Renal replacement therapy is independently associated with a lower risk of death in patients with severe acute kidney injury treated with targeted temperature management after out-of-hospital cardiac arrest

被引：15

作者：

Choi, Yoon Hee ^{[1
,2
]}

Lee, Dong Hoon ^{[3
]}

Oh, Je Hyeok ^{[3
]}

Wee, Jung Hee ^{[4
]}

Jang, Tae Chang ^{[5
]}

Choi, Seung Pill ^{[6
]}

Park, Kyu Nam ^{[7
]}

机构：

[1] Ewha Womans Univ, Dept Emergency Med, Med Ctr, 1071 Anyangcheon Ro, Seoul 07985, South Korea

[2] Ewha Womans Univ, Mokdong Hosp, 1071 Anyangcheon Ro, Seoul 07985, South Korea

[3] Chung Ang Univ, Coll Med, Dept Emergency Med, 84 Heukseok Ro, Seoul 06974, South Korea

[4] Wonkwang Univ, Coll Med, Dept Emergency Med, Sanbon Hosp, 321 Snabon Ro, Gunpo Si 15865, Gyeonggi Do, South Korea

[5] Daegu Catholic Univ, Sch Med, Dept Emergency Med, 33 Duryugongwon Ro 17 Gil, Daegu 42472, South Korea

[6] Catholic Univ Korea, Dept Emergency Med, Eunpyeong St Marys Hosp, Coll Med, 1021 Tongil Ro, Seoul 03312, South Korea

[7] Catholic Univ Korea, Dept Emergency Med, Coll Med, Seoul St Marys Hosp, 222 Banpo Daero, Seoul 06591, South Korea

来源：

CRITICAL CARE | 2020年 / 24卷 / 01期

基金：

新加坡国家研究基金会;

关键词：

Renal replacement therapy; Acute kidney injury; Out-of-hospital cardiac arrest; Targeted temperature management; Therapeutic hypothermia; CARDIOPULMONARY-RESUSCITATION; GUIDELINES; RECOVERY; SURVIVAL; IMPACT; CARE; AKI;

D O I：

10.1186/s13054-020-2822-x

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background: The effect of renal replacement therapy (RRT) on the outcomes of severe acute kidney injury (AKI) after out-of-hospital cardiac arrest (OHCA) is uncertain. This study aimed to evaluate the association of RRT with 6-month mortality in patients with severe AKI treated with targeted temperature management (TTM) after OHCA. Methods: This was a retrospective analysis of a prospectively collected multicentre observational cohort study that included adult OHCA patients treated with TTM across 22 hospitals in South Korea between October 2015 and December 2018. AKI was diagnosed using the Kidney Disease: Improving Global Outcomes criteria. The primary outcome was 6-month mortality and the secondary outcome was cerebral performance category (CPC) at 6 months. Multivariate Cox regression analysis was performed to define the role of RRT in stage 3 AKI. Results: Among 10,426 patients with OHCA, 1373 were treated with TTM. After excluding those who died within 48 h of return of spontaneous circulation (ROSC) and those with pre-arrest chronic kidney disease, our study cohort comprised 1063 patients. AKI developed in 590 (55.5%) patients and 223 (21.0%) had stage 3 AKI. Among them, 115 (51.6%) were treated with RRT. The most common treatment modality among RRT patients was continuous renal replacement therapy (111 [96.5%]), followed by intermittent haemodialysis (4 [3.5%]). The distributions of CPC (1-5) at 6 months for the non-RRT vs. the RRT group were 3/108 (2.8%) vs. 12/115 (10.4%) for CPC 1, 0/108 (0.0%) vs. 1/115 (0.9%) for CPC 2, 1/108 (0.9%) vs. 3/115 (2.6%) for CPC 3, 6/108 (5.6%) vs. 6/115 (5.2%) for CPC 4, and 98/108 (90.7%) vs. 93/115 (80.9%) for CPC 5, respectively (P = 0.01). The RRT group had significantly lower 6-month mortality than the non-RRT group (93/115 [81%] vs. 98/108 [91%], P = 0.04). Multivariate Cox regression analyses showed that RRT was independently associated with a lower risk of death in patients with stage 3 AKI (hazard ratio, 0.569 [95% confidence interval, 0.377-0.857, P = 0.01]). Conclusion: Dialysis interventions were independently associated with a lower risk of death in patients with stage 3 AKI treated with TTM after OHCA.

引用

页数：11

共 26 条

[1]

[Anonymous], 2012, Kidney Int Suppl (2011), V2, P89

[2]

[Anonymous], 2012, Kidney Int Supplements, DOI DOI 10.1038/KISUP.2011.32

[3] Impact of acute kidney injury on patient outcome in out-of-hospital cardiac arrest: a prospective observational study [J].