Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis

被引：39

作者：

Barbar, S. D. ^{[1
]}

Clere-Jehl, R. ^{[5
]}

Bourredjem, A. ^{[6
,7
,8
,9
,10
]}

Hernu, R. ^{[11
]}

Montini, F. ^{[12
]}

Bruyere, R. ^{[13
]}

Lebert, C. ^{[14
]}

Bohe, J. ^{[15
]}

Badie, J. ^{[16
]}

Eraldi, J-P ^{[17
]}

Rigaud, J-P ^{[17
]}

Levy, B. ^{[18
]}

Siami, S. ^{[19
]}

Louis, G. ^{[20
]}

Bouadma, L. ^{[21
,22
]}

Constantin, J-M ^{[24
,25
]}

Mercier, E. ^{[26
]}

Klouche, K. ^{[4
]}

du Cheyron, D. ^{[27
]}

Piton, G. ^{[28
]}

Annane, D. ^{[30
,31
]}

Jaber, S. ^{[2
,3
]}

van der Linden, T. ^{[32
]}

Blasco, G. ^{[29
]}

Mira, J-P ^{[23
]}

Schwebel, C. ^{[33
]}

Chimot, L. ^{[34
]}

Guiot, P. ^{[35
]}

Nay, M-A ^{[36
,37
]}

Meziani, F. ^{[5
]}

Helms, J. ^{[5
]}

Roger, C.

Louart, B. ^{[1
]}

Trusson, R. ^{[1
]}

Dargent, A. ^{[6
,7
,8
]}

Binquet, C. ^{[9
,10
]}

Quenot, J-P ^{[6
,7
,8
,9
,10
]}

机构：

[1] CHU Nimes, Reanimat Med, Nimes, France

[2] Univ Montpellier, St Eloi CHU Montpellier, Montpellier, France

[3] INSERM, Unite 1046, Montpellier, France

[4] CHU Lapeyronie, Serv Reanimat Med, Montpellier, France

[5] Univ Strasbourg, Fac Med, Hop Univ Strasbourg, Serv Reanimat,Nouvel Hop Civil, Strasbourg, France

[6] Hop Univ Francois Mitterrand, Serv Med Intens Reanimat, Dijon, France

[7] INSERM, Lipness Team, Res Ctr Lipids Nutr Canc, Unite Mixte Rech 1231, Dijon, France

[8] Lab Excellence LipSTIC, Dijon, France

[9] CHU Dijon Bourgogne, Ctr Invest Clin Epidemiol Clin, Dijon, France

[10] Univ Bourgogne, INSERM, Ctr Invest Clin 1432, Dijon, France

[11] Hosp Civils Lyon, Hop Edouard Herriot, Reanimat Med, Lyon, France

[12] Ctr Hosp Avignon, Reanimat Polyvalente, Avignon, France

[13] Ctr Hosp Bourg En Bresse, Reanimat Polyvalente, Bourg En Bresse, France

[14] Ctr Hosp La Roche Sur Yon, Serv Med Intens Reanimat, La Roche Sur Yon, France

[15] Ctr Hosp Lyon Sud, Intens Care Unit, Hosp Civils Lyon, Pierre Benite, France

[16] Hop Nord Franche Comte, Reanimat Polyvalente, Belfort, France

[17] Ctr Hosp Dieppe, Med Intens Reanimat, Dieppe, France

[18] CHU Nancy Brabois, Serv Reanimat Med, Nancy, France

[19] Ctr Hosp Etampes, Serv Anesthesie Reanimat, Etampes, France

[20] Hop Bon Secours, Ctr Hosp Reg Metz, Reanimat Polyvalente, Metz, France

[21] Univ Paris Diderot, Team Decis Sci Infect Dis Prevent Control & Care, Infect Antimicrobiens Modelisat Evolut, Sorbonne Paris Cite,Unite 1137, Paris, France

[22] Bichat Claude Bernard Hosp, AP HP, Med & Infect Dis ICU, Paris, France

[23] Hop Cochin, Serv Reanimat Med, Paris, France

[24] CHU Clermont Ferrand, Pole Med Perioperatoire, GReD, Clermont Ferrand, France

[25] CHU Clermont Ferrand, INSERM, Unite 1103, Clermont Ferrand, France

[26] CHU Reg Tours, Serv Reanimat Med, Tours, France

[27] CHU Caen, Serv Reanimat Med, Caen, France

[28] CHU Besancon, Serv Reanimat Med, Besancon, France

[29] CHU Besancon, Serv Reanimat Chirurg, Besancon, France

[30] Hop Raymond Poincare, Serv Med Intens & Reanimat, Garches, France

[31] Univ Versailles St Quentin En Yvelines, INSERM, Unite 1173, Lab Infect & Inflammat, Montigny Le Bretonneux, France

[32] Univ Catholique Lille, Grp Hop, Inst Catholique Lille, Serv Med Intens Reanimat, Lille, France

[33] CHU Grenoble, Serv Reanimat Med, Grenoble, France

[34] Ctr Hosp Perigueux, Serv Reanimat, Perigueux, France

[35] Ctr Hosp Gen Mulhouse, Serv Reanimat Polyvalente, Mulhouse, France

[36] Ctr Hosp Reg Orleans, Med Intens Reanimat, Orleans, France

[37] CHU Nimes, Reanimat Chirurg, Nimes, France

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2018年 / 379卷 / 15期

关键词：

INTERNATIONAL CONSENSUS CONFERENCE; CRITICALLY-ILL PATIENTS; ORGAN FAILURE; INITIATION; HEMOFILTRATION;

D O I：

10.1056/NEJMoa1803213

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Acute kidney injury is the most frequent complication in patients with septic shock and is an independent risk factor for death. Although renal-replacement therapy is the standard of care for severe acute kidney injury, the ideal time for initiation remains controversial. METHODS In a multicenter, randomized, controlled trial, we assigned patients with early-stage septic shock who had severe acute kidney injury at the failure stage of the risk, injury, failure, loss, and end-stage kidney disease (RIFLE) classification system but without life-threatening complications related to acute kidney injury to receive renal-replacement therapy either within 12 hours after documentation of failure-stage acute kidney injury (early strategy) or after a delay of 48 hours if renal recovery had not occurred (delayed strategy). The failure stage of the RIFLE classification system is characterized by a serum creatinine level 3 times the baseline level (or >= 4 mg per deciliter with a rapid increase of >= 0.5 mg per deciliter), urine output less than 0.3 ml per kilogram of body weight per hour for 24 hours or longer, or anuria for at least 12 hours. The primary outcome was death at 90 days. RESULTS The trial was stopped early for futility after the second planned interim analysis. A total of 488 patients underwent randomization; there were no significant betweengroup differences in the characteristics at baseline. Among the 477 patients for whom follow-up data at 90 days were available, 58% of the patients in the early-strategy group (138 of 239 patients) and 54% in the delayed-strategy group (128 of 238 patients) had died (P = 0.38). In the delayed-strategy group, 38% (93 patients) did not receive renal-replacement therapy. Criteria for emergency renal-replacement therapy were met in 17% of the patients in the delayed-strategy group (41 patients). CONCLUSIONS Among patients with septic shock who had severe acute kidney injury, there was no significant difference in overall mortality at 90 days between patients who were assigned to an early strategy for the initiation of renal-replacement therapy and those who were assigned to a delayed strategy. (Funded by the French Ministry of Health; IDEAL-ICU ClinicalTrials.gov number, NCT01682590.)

引用

页码：1431 / 1442

页数：12

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