急性肾损伤患者早期与晚期开始肾脏替代治疗对预后的影响

Effect of Early Versus Late Initiation of Renal Replacement Therapy in Patients with Acute Kidney Injury on Prognosis

目的:了解急性肾损伤患者不同透析时机对预后的影响。方法:回顾性调查解放军总医院2013年01月～2017年08月发生急性肾损伤(AKI)且行RRT治疗的住院患者,收集患者的人口学资料、伴随疾病、RRT启动时的生命体征、实验室检查、APACHEⅡ评分、SOFA评分、RRT方式及时间,分析AKI病因。以RRT前24 h体重调整后每小时中位数尿量为界,分为早期RRT治疗组及晚期RRT治疗组。对比早期RRT组与晚期RRT组之间的数据特点,通过倾向评分减少两组间的差异后,再对比患者28天死亡率和肾脏预后。Logistic回归分析影响患者的死亡危险因素。结果:总体患者28 d死亡率34. 4%,早期组死亡率30%,晚期组死亡率38. 9%,两组间没有显著性差异(P=0. 097),通过倾向评分匹配后,早期组死亡率29. 8%,晚期组38. 8%,两组间没有显著性差异(P=0. 136)。无论是否通过倾向评分匹配,早期的肾脏预后都要好于晚期组(P <0. 001)。多因素Logistic回归分析影响患者的死亡危险因素是年龄、肿瘤、APACHEⅡ评分、机械通气。结论:早期开始RRT治疗并没有给患者短期生存带来收益,但肾脏预后要好于晚期。影响患者的死亡危险因素是年龄、肿瘤、APACHEⅡ评分、机械通气。

Objective: To understand the effect of different dialysis timing on prognosis in patients with acute kidney injury.Methods: A retrospective survey of hospitalized patients with AKI who underwent RRT from January 2013 to August 2017 in the People’s Liberation Army General Hospital. Collect patients’ Demographic data,concomitant diseases,vital signs at the initiation of RRT,Laboratory tests,APACHE Ⅱ scoreand SOFA scores before RRT,RRT method and RRT time,analyze the cause of AKI. The median urine volume per hour after weight adjustment for the 24 hours before RRT was adjusted to the early RRT treatment group and the late RRT treatment group. Comparing the data characteristics between the early RRT group and the late group,reduce differences between the two groups by propensity score,and then the 28-day mortality and renal prognosis were compared. Logistic regression analysis of risk factors for death in patients. Results: The overall 28-day mortality rate was 34. 4%,the early group mortality was 30%,and the late group mortality was 38. 9%. There was no significant difference between the two groups( P = 0. 097). After matching the propensity score,the early group mortality was 29. 8%. There were 38. 8% in the late group and there was no significant difference between the two groups( P = 0. 136). Early kidney prognosis is better than late group,whether or not matched by propensity score. Multivariate logistic regression analysis of the risk factors for death in patients was age,tumor,APACHE Ⅱ score,and mechanical ventilation.Conclusion: Early initiation of RRT did not benefit in patients with short-term survival,but the renal prognosis was better than late.Risk factors for mortality in patients were age,tumor,APACHE Ⅱ score,and mechanical ventilation.