Timing of continuous renal replacement therapy in severe acute kidney injury patients with fluid overload: A retrospective cohort study

被引:10
作者
Lin, J. [1 ]
Ji, X. J. [1 ]
Wang, A. Y. [2 ,3 ]
Liu, J. F. [1 ]
Liu, P. [1 ]
Zhang, M. [1 ]
Qi, Z. L. [1 ]
Guo, D. C. [1 ]
Bellomo, R. [2 ,5 ]
Bagshaw, S. M. [6 ]
Wald, R. [7 ]
Gallagher, M. [2 ,3 ,4 ]
Duan, M. L. [1 ]
机构
[1] Capital Med Univ, Beijing Friendship Hosp, Dept Crit Care Med, Beijing, Peoples R China
[2] George Inst Global Hlth, Newtown, NSW 2042, Australia
[3] Univ Sydney, Concord Clin Sch, Sydney, NSW 2006, Australia
[4] Concord Repatriat Gen Hosp, Dept Renal Med, Concord, NSW 2139, Australia
[5] Austin Hosp, Dept Intens Care, Heidelberg, Vic 3084, Australia
[6] Univ Alberta, Fac Med & Dent, Dept Crit Care Med, Edmonton, AB T6G 2R3, Canada
[7] Univ Toronto, Li Ka Shing Knowledge Inst, St Michaels Hosp, Div Nephrol, Toronto, ON M5S 1A1, Canada
关键词
Acute kidney injury; Mortality; Continuous renal replacement therapy; Fluid overload; CRITICALLY-ILL PATIENTS; BALANCE; MORTALITY; INITIATION; MANAGEMENT; EPIDEMIOLOGY; PREDICTORS; INTENSITY; RECOVERY; SUPPORT;
D O I
10.1016/j.jcrc.2021.04.017
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Purpose: We aimed to evaluate the association of early versus late initiation of Continuous renal replacement therapy (CRRT) with mortality in patients with fluid overload. Methods: This was a retrospective cohort study of patients with fluid overload (FO) treated with CRRT due to severe acute kidney injury (AKI) between January 2015 and December 2017 in a mixed medical intensive care unit of a teaching hospital in Beijing, China. Patients were divided into early (<= 15 h) and late (>15 h) groups based on the median time from ICU admission to CRRT initiation. The primary outcome was all-cause mortality at day 60. Multivariable Cox model analysis was used for analysis. Results: The study patients were male predominant (84/150) with a mean age of 64.8 +/- 16.7 years. The median FO value before CRRT initiation was 10.1% [6.2-16.1%]. The 60-day mortality rates in the early vs the late CRRT groups were 53.9% and 73%, respectively. On multivariable Cox modelling, the late initiation of CRRT was independently associated with an increased risk of death at 60 days (HR 1.75, 95% CI 1.11-;2.74, p = 0.015). Conclusions: Early initiation of CRRT was independently associated with survival benefits in severe AKI patients with fluid overload. (c) 2021 Published by Elsevier Inc.
引用
收藏
页码:226 / 236
页数:11
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