Development of a Decision Aid for Family Surrogate Decision Makers of Critically Ill Patients Requiring Renal Replacement Therapy in ICU:A User-Centered Design for Rapid Prototyping

Objectives Renal replacement therapy(RRT)is increasingly adopted for critically ill patients diagnosed with acute kidney injury,but the optimal time for initiation remains unclear and prognosis is uncertain,leading to medical complexity,ethical conflicts,and decision dilemmas in intensive care unit(ICU)settings.This study aimed to develop a decision aid(DA)for the family surrogate of critically ill patients to support their engagement in shared decision-making process with clinicians.Methods Development of DA employed a systematic process with user-centered design(UCD)principle,which included:(i)competitive analysis:searched,screened,and assessed the existing DAs to gather insights for design strategies,developmental techniques,and functionalities;(ii)user needs assessment:interviewed family surrogates in our hospital to explore target user group's decision-making experience and identify their unmet needs;(iii)evidence syntheses:integrate latest clinical evidence and pertinent information to inform the content development of DA.Results The competitive analysis included 16 relevant DAs,from which we derived valuable insights using existing resources.User decision needs were explored among a cohort of 15 family surrogates,revealing four thematic issues in decision-making,including stuck into dilemmas,sense of uncertainty,limited capacity,and delayed decision confirmation.A total of 27 articles were included for evidence syntheses.Relevant decision making knowledge on disease and treatment,as delineated in the literature sourced from decision support system or clinical guidelines,were formatted as the foundational knowledge base.Twenty-one items of evidence were extracted and integrated into the content panels of benefits and risks of RRT,possible outcomes,and reasons to choose.The DA was drafted into a web-based phototype using the elements of UCD.This platform could guide users in their preparation of decision-making through a sequential four-step process:identifying treatment options,weighing the benefits and risks,clarifying personal preferences and values,and formulating a schedule for formal shared decision-making with clinicians.Conclusions We developed a rapid prototype of DA tailored for family surrogate decision makers of critically ill patients in need of RRT in ICU setting.Future studies are needed to evaluate its usability,feasibility,and clinical effects of this intervention.

Management of regional citrate anticoagulation for continuous renal replacement therapy:guideline recommendations from Chinese emergency medical doctor consensus

Continuous renal replacement therapy(CRRT)is widely used for treating critically-ill patients in the emergency department in China.Anticoagulant therapy is needed to prevent clotting in the extracorporeal circulation during CRRT.Regional citrate anticoagulation(RCA)has been shown to potentially be safer and more effective,and is now recommended as the preferred anticoagulant method for CRRT.However,there is still a lack of unified standards for RCA management in the world,and there are many problems in using this method in clinical practice.The Emergency Medical Doctor Branch of the Chinese Medical Doctor Association(CMDA)organized a panel of domestic emergency medicine experts and international experts of CRRT to discuss RCA-related issues,including the advantages and disadvantages of RCA in CRRT anticoagulation,the principle of RCA,parameter settings for RCA,monitoring of RCA(mainly metabolic acid-base disorders),and special issues during RCA.Based on the latest available research evidence as well as the paneled experts'clinical experience,considering the generalizability,suitability,and potential resource utilization,while also balancing clinical advantages and disadvantages,a total of 16 guideline recommendations were formed from the experts'consensus.

Eff ects of continuous renal replacement therapy on infl ammation-related anemia, iron metabolism and prognosis in sepsis patients with acute kidney injury

BACKGROUND:This study aims to evaluate the eff ect of continuous renal replacement therapy(CRRT)on inflammation-related anemia,iron metabolism,and the prognosis in sepsis patients with acute kidney injury(AKI).METHODS:Sepsis patients with AKI were prospectively enrolled and randomized into the CRRT and control groups.The clinical and laboratory data on days 1,3 and 7 after intensive care unit(ICU)admission were collected.The serum interleukin(IL)-6,hepcidin,erythropoietin,ferritin,and soluble transferrin receptor(sTfR)were determined by enzyme-linked immunosorbent assay.The Sequential Organ Failure Assessment(SOFA)score and 28-day mortality were recorded.Data were analyzed using Pearson’s Chi-square test or Fisher’s exact test(categorical variables),and Mann-Whitney U-test or t-test(continuous variables).RESULTS:The hemoglobin and serum erythropoietin levels did not signifi cantly diff er between the CRRT and control groups though gradually decreased within the first week of ICU admission.On days 3 and 7,the serum IL-6,hepcidin,ferritin,and red blood cell distribution width significantly decreased in the CRRT group compared to the control group(all P<0.05).On day 7,the serum iron was significantly elevated in the CRRT group compared to the control group(P<0.05).However,the serum sTfR did not signifi cantly diff er between the groups over time.In addition,the SOFA scores were signifi cantly lower in the CRRT group compared to the control group on day 7.The 28-day mortality did not signifi cantly diff er between the control and CRRT groups(38.0%vs.28.2%,P=0.332).CONCLUSION:CRRT might have beneficial effects on the improvement in inflammationrelated iron metabolism and disease severity during the fi rst week of ICU admission but not anemia and 28-day mortality in sepsis patients with AKI.

影响慢性肾衰竭CRRT患者细菌感染发生的独立危险因素分析

目的 探讨影响慢性肾衰竭连续肾脏替代疗法(CRRT)患者发生细菌感染的独立危险因素。方法 回顾性分析2019年12月~2022年12月在运城市中心医院进行CRRT治疗的1 000例慢性肾衰竭患者。记录发生细菌感染的患者例数,分析细菌感染病原菌分布状况。将细菌感染患者267例设为观察组,余下未感染患者733例设为对照组,比较两组基线资料,并将有差异的指标纳入二元logistic回归分析,得到影响慢性肾衰竭CRRT患者出现细菌感染的独立危险因素。结果 1 000例慢性肾衰竭CRRT治疗患者,共发生细菌感染267例(观察组),发生率为26.70%;未发生细菌感染733例(对照组)。两组患者年龄、治疗时间、体质量指数(BMI)、合并糖尿病、糖尿病肾病、合并心力衰竭、留置静脉导管、血红蛋白(Hb)及血清白蛋白差异比较具有统计学意义(χ^(2)=8.123、5.463、8.631、5.043、8.898、8.052、4.861、8.658、4.803,P<0.05)。多因素logistic回归分析结果显示,≥65岁、≥1年治疗时间、BMI <20 kg/m2、合并糖尿病、合并心力衰竭、留置静脉导管、糖尿病肾病、Hb <70 g/L及血清白蛋白<30 g/L为影响慢性肾衰竭患者CRRT治疗过程中出现细菌感染的独立危险因素(P<0.05)。结论 慢性肾衰竭CRRT患者年龄、治疗时间、BMI、合并糖尿病与心力衰竭、留置静脉导管、糖尿病肾病、Hb及血清白蛋白均可影响细菌感染的发生,临床应针对上述危险因素构建干预方案,预防细菌感染。

Effects of plasma exchange combined with continuous renal replacement therapy on acute fatty liver of pregnancy

BACKGROUND: Acute fatty liver of pregnancy (AFLP) in the third trimester or early postpartum period can lead to fatal liver damage. Its traditional therapy is not very effective in facilitating hepatic recovery. The safety and effect of plasma exchange (PE)in combination with continuous renal replacement therapy(CRRT) (PE+CRRT) for AFLP still needs evaluation.METHODS: Five AFLP patients with hepatic encephalopathy and renal failure were subjected to PE+CRRT in our department from 2007 to 2012. Their symptoms, physical signs and results were observed, and all relevant laboratory tests were compared before and after PE+CRRT.RESULTS: All the 5 patients were well tolerated to the therapy. Four of them responded to the treatment and showed improvement in clinical symptoms/signs and laboratory results and they were cured and discharged home after the treatment One patient succeeded in bridging to transplantation for slowing down hepatic failure and its complications process after2 treatment sessions. Intensive care unit stay and hospital stay were 9.4 (range 5-18) and 25.0 days (range 11-42), respectively.CONCLUSION: PE+CRRT is safe and effective and should be used immediately at the onset of hepatic encephalopathy and/or renal failure in patients with AFLP.

伴高乳酸血症的重症患者行局部CRA-CRRT治疗的有效性和安全性研究

目的研究伴高乳酸血症的重症患者行局部枸橼酸抗凝(CRA)-连续性肾脏替代(CRRT)治疗的有效性和安全性。方法收集2021年10月-2023年3月于新疆医科大学第一附属医院呼吸重症监护室进行RCA-CRRT治疗的67例伴高乳酸血症(2 mmol/L<乳酸值<10 mmol/L)的重症患者临床资料,按局部抗凝方式分为对照组(低分子肝素抗凝)20例和CRA组(枸橼酸抗凝)47例。收集患者一般资料及CRRT治疗前及治疗24 h患者乳酸值、pH值、碳酸氢根离子(HCO_(3)^(-))、滤器后血清离子钙(iCa^(2+))、体内iCa^(2+)、血清总钙、血钠离子(Na+)、镁离子(Mg^(2+));统计滤器结局、血液制品输注情况、出血事件发生率及死亡率,记录CRA相关并发症发生情况。结果两组一般资料比较,差异均无统计学意义(P>0.05);与本组治疗前比较,CRRT治疗24 h两组乳酸值水平均降低,iCa^(2+)、pH、HCO3-水平升高(P<0.05);CRRT治疗24 h后,两组患者总钙、总钙/iCa^(2+)比值、Na+、Mg^(2+)水平比较,差异均无统计学意义(P>0.05)。与对照组比较,CRA组滤器平均使用寿命延长,差异有统计学意义(P<0.05),两组治疗期间出血事件发生率、血液制品输注情况、死亡率差异均无统计学意义(P>0.05);两组患者治疗24 h滤器或管路凝血发生率等级分布比较,差异有统计学意义(P<0.05),且CRA组Ⅱ/Ⅲ级凝血发生率低于对照组(P<0.05);两组患者枸橼酸蓄积、代谢性酸中毒、代谢性碱中毒发生率及总并发症发生率比较,差异无统计学意义(P>0.05)。结论伴高乳酸血症的重症患者行CRA-CRRT治疗有助于降低血乳酸水平,纠正酸中毒,减少凝血和出血风险,延长滤器寿命,枸橼酸蓄积风险低。

采用自配碳酸氢盐置换液行CRRT治疗流行性出血热合并急性肾功能衰竭1例回顾性分析

目的总结1例流行性出血热(EHF)合并急性肾功能衰竭(ARF)患者采用自配碳酸氢盐置换液行连续性肾脏替代治疗(CRRT)的经验,以期为同类病例的治疗提供参考。方法对2021年4月兰州大学第一医院东岗院区综合内科收治的1例EHF合并ARF患者行内科综合治疗,同时采用自配碳酸氢盐置换液行CRRT,依据动态监测血气分析、电解质、肾功能及凝血指标水平调整自配置换液配方及抗凝剂剂量。结果患者住院治疗14 d出院,出院后30 d复查随访,各项指标均恢复正常。结论在内科综合治疗的同时及时采用自配碳酸氢盐置换液行CRRT是治疗EHF合并ARF的有效方法。

Effects of prostaglandin E combined with continuous renal replacement therapy on septic acute kidney injury

BACKGROUND The effects of prostaglandin E(PGE)combined with continuous renal replacement therapy(CRRT)on renal function and inflammatory responses in patients with septic acute kidney injury(SAKI)remain unclear.AIM To investigate the effects of PGE combined with CRRT on urinary augmenter of liver regeneration(ALR),urinary Na+/H+exchanger 3(NHE3),and serum inflammatory cytokines in patients with SAKI.METHODS The clinical data of 114 patients with SAKI admitted to Yichang Second People's Hospital from May 2017 to January 2019 were collected.Fifty-three cases treated by CRRT alone were included in a control group,while the other 61 cases treated with PGE combined with CRRT were included in an experimental group.Their urinary ALR,urinary NHE3,serum inflammatory cytokines,renal function indices,and immune function indices were detected.Changes in disease recovery and the incidence of adverse reactions were observed.The 28-d survival curve was plotted.RESULTS Before treatment,urinary ALR,urinary NHE3,blood urea nitrogen(BUN),serum creatinine(SCr),CD3+T lymphocytes,CD4+T lymphocytes,and CD4+/CD8+T lymphocyte ratio in the control and experimental groups were approximately the same.After treatment,urinary ALR and NHE3 decreased,while BUN,SCr,CD3+T lymphocytes,CD4+T lymphocytes,and CD4+/CD8+T lymphocyte ratio increased in all subjects.Urinary ALR,urinary NHE3,BUN,and SCr in the experimental group were significantly lower than those in the control group,while CD3+T lymphocytes,CD4+T lymphocytes,and CD4+/CD8+T lymphocyte ratio were significantly higher than those in the control group(P<0.05).After treatment,the levels of tumor necrosis factor-α,interleukin-18,and high sensitivity C-reactive protein in the experimental group were significantly lower than those in the control group(P<0.05).The time for urine volume recovery and intensive care unit treatment in the experimental group was significantly shorter than that in the control group(P<0.05),although there was no statistically significant difference in hospital stays between the two groups.The total incidence of adverse reactions did not differ statistically between the two groups.The 28-d survival rate in the experimental group(80.33%)was significantly higher than that in the control group(66.04%).CONCLUSION PGE combined with CRRT is clinically effective for treating SAKI,and the combination therapy can significantly improve renal function and reduce inflammatory responses.

Optimal indicator for changing the filter during the continuous renal replacement therapy in intensive care unit patients with acute kidney injury:A crossover randomized trial

BACKGROUND:The study aims to investigate an optimal indicator for changing the filter during the continuous renal replacement therapy(CRRT)in intensive care unit(ICU)patients with acute kidney injury(AKI).METHODS:Patients with AKI requiring CRRT in an ICU were randomly divided into two groups for crossover trial,i.e.,groups A and B.Patients in the group A were firstly treated with continuous veno-venous hemofiltration(CVVH),followed by continuous veno-venous hemodiafiltration(CVVHDF).Patients in the group B were firstly treated with CVVHDF followed by CVVH.Delivered doses of solutes with different molecular weights at the indicated time points between groups were compared.A correlation analysis between the delivered dose and pre-filter pressure(P_(PRE))and transmembrane pressure(P_(TM))was performed.Receiver operating characteristic(ROC)curves were constructed to evaluate the accuracy of P_(TM) as an indicator for filter replacement.RESULTS:A total of 50 cases were analyzed,27 in the group A and 23 in the group B.Delivered doses of different molecular-weight solutes significantly decreased before changing the filter in both modalities,compared with those at the initiation of treatment(all P<0.05).In the late stage of CRRT,the possible rebound of serum medium-molecular-weight solute concentration was observed.P_(TM) was negatively correlated with the delivered dose of medium-molecular-weight solute in both modalities.The threshold for predicting the rebound of serum concentration of medium-molecularweight solute by P_(TM) was 146.5 mm Hg(1 mm Hg=0.133 k Pa).CONCLUSIONS:The filter can be used as long as possible within the manufacturer’s safe use time limits to remove small-molecular-weight solutes.P_(TM) of 146.5 mm Hg may be an optimal indicator for changing the filter in CRRT therapies to remove medium-molecular-weight solutes.

Renal Replacement Therapy in Qatar—Past, Present and Future

The economic development of Qatar alongside the resultant lifestyle changes in the last few decades has contributed to increasing rates of obesity, diabetes mellitus and hypertension with consequent increased incidence and prevalence of chronic kidney disease and end-stage-renal-disease (ESRD). This article describes renal replacement therapy (RRT) services in Qatar and their evolution in response to challenges posed by the growth of ESRD with reference to regional and international data. It covers the history of RRT, highlighting significant advances in chronological order, as well as providing an overview of the current status of RRT in the multicultural and socioeconomically diverse society that inhabits Qatar. Finally, it casts a glance into the future, predicting how RRT services will further evolve to address the current limitations.

Therapeutic plasma exchange and continuous renal replacement therapy for severe hyperthyroidism and multi-organ failure:A case report

BACKGROUND Severe hyperthyroidism is a life-threatening exacerbation of thyrotoxicosis,characterized by high fever and multiorgan failure. The most common medical treatments are administration of antithyroid drugs and radioactive iodine, and thyroidectomy. In some patients, antithyroid therapy is limited due to serious adverse effects or failure to control disease progression. In some extreme cases,such as thyroid storm, conventional therapy alone does not yield effective and rapid improvement before the development of multiorgan failure.CASE SUMMARY This report describes a Chinese patient with severe hyperthyroidism accompanied by multiorgan failure, who was transferred to the medical intensive care unit of our hospital. The patient presented with palpitations, vomiting,diarrhea, and shortness of breath for a week. Laboratory tests showed elevation of thyroid hormones. Hepatic failure occurred with high aminotransferase levels and jaundice. Given her abnormal liver function and medication history, we could not exclude diagnosis of propylthiouracil-induced hepatic failure.Moreover, she also suffered from heart failure. Therapeutic plasma exchange(commonly known as TPE) and continuous renal replacement therapy(commonly known as CRRT) were used as life-saving therapy, which resulted in notable improvement of clinical symptoms and laboratory tests.CONCLUSION Combined TPE and CRRT are safe and effective for patients with hyperthyroidism and multiorgan failure.

Evaluation of the Pharmacokinetics of Nafamostat Mesylate during Continuous Renal Replacement Therapy

Continuous renal replacement therapy (CRRT) is the preferred dialysis modality in critical care settings for patients with hemodynamic instability. Nafamostat mesylate (NM) is an anticoagulant commonly used (mainly in Japan) during CRRT in patients with high bleeding risk. In this study, we evaluated the pharmacokinetics of NM during CRRT. Patients undergoing CRRT therapy and using NM as the anticoagulant in the intensive care unit were enrolled in the study. Blood was collected from the CRRT circuit just after blood removal, just before and after the membrane for CRRT, and from the filtrates after the membrane. NM concentrations were measured using high-performance liquid chromatography. NM was detected in the intracorporeal circulation during CRRT in some cases, and liver enzymes were severely elevated in almost all of the cases. Coagulation time was prolonged even before the initiation of NM administration in these cases and may be associated with liver damage. This study suggests that NM dosage should take into account liver damage assessed by elevated liver enzymes.

When to initiate renal replacement therapy: The trend of dialysis initiation

The timing of renal replacement therapy for patients with end-stage renal disease has been subject to considerable variation. The United States Renal Data System shows an ascending trend of early dialysis initiation until 2010, at which point it decreased slightly for the following 2 years. In the 1990 s, nephrologists believed that early initiation of dialysis could improve patient survival. Based on the Canadian-United States Peritoneal Dialysis study, the National Kidney Foundation Dialysis Outcomes Quality Initiative recommended that dialysis should be initiated early. Since 2001, several observational studies and 1 randomized controlled trial have found no beneficial effect when patients were placed on dialysis early. In contrast, they found that an increase in mortality was associated with early dialysis initiation. The most recent dialysis initiation guidelines recommend that dialysis should be initiated at an estimated glomerular filtration rate(e GFR) of greater than or equal to 6 mL /min per 1.73 m2. Nevertheless, the decision to start dialysis is mainly based on a predefined eG FR value, and no convincing evidence has demonstrated that patients would benefit from early dialysis initiation as indicated by the eG FR. Even today, the optimal dialysis initiation time remains unknown. The decision of when to start dialysis should be based on careful clinical evaluation.

注射用甲磺酸萘莫司他在急性肾损伤CRRT治疗中的应用效果

目的 研究注射用甲磺酸萘莫司他(NM)在急性肾损伤连续肾脏替代治疗(CRRT)治疗中的应用效果。方法 选择本院2023年1月至2024年1月收治的76例AKI患者,按照随机数字表法分为对照组(n=38)与研究组(n=38),对照组采用局部枸橼酸抗凝(RCA),研究组采用注射用NM抗凝,比较两组CRRT治疗前和治疗后3 d的肾功能指标(尿酸、尿素氮、血肌酐),凝血指标(血小板计数、纤维蛋白原、凝血酶原时间、活化部分凝血酶原时间),血清钾、钙及钠离子水平;评估CRRT治疗期间的不良反应和过滤器的平均使用寿命时间。结果 两组治疗前肾功能指标、凝血指标、血清钾、钙及钠离子水平差异无统计学意义(P>0.05);两组治疗后肾功能指标、血小板计数均较治疗前下降(P<0.05),纤维蛋白原、凝血酶原时间、活化部分凝血酶原时间均较治疗前上升(P<0.05),组间差异无统计学意义(P>0.05);研究组治疗后血清钾、钙、钠离子浓度与治疗前差异无统计学意义(P>0.05),对照组治疗后血清钙较治疗前下降(P<0.05),血清钠较治疗前上升(P<0.05)。研究组不良反应总发生率较对照组低(P<0.05)。对照组与研究组过滤器使用寿命时间分别为(23.08±3.29)h比(23.43±3.04)h(P>0.05)。结论 注射用NM在急性肾损伤CRRT治疗中对患者凝血功能、钾钙钠离子的影响较小,可促进患者肾功能恢复,与RCA比较未能延长过滤器使用寿命,但注射用NM的安全性更高。

Renal Replacement Therapy in Patients over 65 Years Old

Age at onset of renal replacement therapy (RRT) is increasing in all countries. Two substitution methods of renal function remain available: hemodialysis (HD) and peritoneal dialysis (PD). It was a retrospective study carried out on January 2015 and it included patients older than 65 years, monitored for HD and PD. We studied their epidemiological and clinical profile, their evolution, and the elements of prognosis. Two groups of 42 patients were included. The first was about 30 HD patients representing 25% of all patients on HD with an average age of 71 ± 4.5 years. The second was concerning 12 patients on PD having a mean age of 69.8 ± 3.5 years and representing 11.7% of all patients on PD. Functional and vital prognosis of a patient with end stage renal disease (ESRD) depends, in the elderly, on psychological, cognitive functions, and the degree of autonomy.

Renal Replacement Therapy in a Caribbean Population: The Impact of Biological, Sociocultural and Demographic Factors

Background: The options for renal replacement therapy for end stage renal disease include haemodialysis (HD), peritoneal dialysis (PD) and renal transplantation. In this study demographic, sociocultural and biological factors were assessed over a 1-year period for patients on renal replacement therapy. Methods: This cross-sectional study included all patients 18 years and older and on renal replacement therapy for at least 3 months in Trinidad and Tobago. Five hundred and thirty participants were recruited from our organ transplantation unit, all centres facilitating PD and a stratified random sample of all HD centres (100 T, 80 PD, 350 HD from October 2015 to October 2016. A questionnaire was administered and included demographics, knowledge and understanding and biological factors impacting on renal replacement therapy. Results: Thirty eight percent of all patients were between 56 to 65 years of age. The Indo Trinidadian population accounted for 51% of the subjects. 52.5% were male and 47.5% were female. From the data, 72% of patients were diabetic and/or hypertensive. In the transplant recipients, 39% were diabetic and/or hypertensive and 27% reported chronic glomerulonephritis as the aetiology of their kidney failure. The diagnosis of chronic kidney disease was made when patients were at end stage renal disease requiring intervention in 84.2% of persons. The employed population of patients constituted 65% of renal transplant recipients, 43.75% of peritoneal dialysis patients and 22.86% of haemodialysis patients. The patient’s physician had the greatest influence on renal replacement therapy choice (85.4% haemodialysis, 85% peritoneal dialysis, 71% transplant). Conclusions: In this cohort of 530 patients on renal replacement therapy, knowledge of therapy and physician’s influence were some of the factors that impacted on choice of therapy. Most patients were already de novo end stage renal disease when the diagnosis of kidney disease was made. Lifestyle diseases-type 2 diabetes mellitus and hypertension were the main causative diseases contributing to renal failure. This study which is the first in the Caribbean to evaluate biological, sociocultural and demographic factors in patients receiving renal replacement will better assist in prevention strategies and resource allocation.

Efficacy of Ulinastatin Combined with Continuous Renal Replacement Therapy in the Treatment of Sepsis Acute Kidney Injury and Its Effects on Systemic Inflammation, Immune Function and miRAN Expression

Objective: To research the effectiveness of ulinastatin in combination with continuous renal replacement therapy in treating sepsis acute kidney injury and its effect on systemic inflammation, immune function and miRAN expression. Methods: The 84 patients who were diagnosed with sepsis complicated by acute kidney injury in our hospital between May 2020 and June 2022 were chosen and randomly assigned to the study group (n = 42) and the control group (n = 42). Ulinastatin in combination with continuous renal replacement therapy was administered to the study group, whereas the control group was administered with continuous renal replacement therapy alone. Both groups’ clinical effects were observed. The levels of blood urea nitrogen (BUN), serum creatinine (SCr), tumor necrosis factor-α (TNF-α), high sensitivity Creactive protein (hs-CRP), vascular cell adhesion molecule-1 (VCAM-1), IgG, IgA, IgM, expression levels of miR-233 and miR-10a were compared among both the groups, pre-, and post-treatment. Results: The study group’s overall effectiveness rate was higher that is 95.24%, in comparison to the control group’s 78.57%, and this difference was statistically significant (P α, hs-CRP, VCAM-1, and miR-233 and miR-10a expression levels in both the study and control groups were decreased, however, the study group had reduced levels in comparison to the control group, with statistically significant differences (P P Conclusion: Ulinastatin in combination with continuous renal replacement therapy for treating sepsis acute kidney injury exhibits a positive effect and can significantly improve the systemic inflammation and immune function in patients.

Study and observation of ultrasound on hemorheology of continuous renal replacement therapy in ICU

Objective: To observe the influence of bedside ultrasound on Hemodynamics of Continuous Renal Replacement Therapy,and explore the clinical value of bedside ultrasound technique in acute kidney injury (AKI) Patients with continuous renal replacement therapy (CRRT) and capacity management. Methods 311 cases of AKI patients with CRRT were divided randomly into Observe group and Control group. the observe group was used bedside ultrasound technique, by monitoring tricuspid annular plane systolic excursion (TAPSE), internal diameter of inferior vena cava (IVC), respiratory variation index of the inferior vena cava internal diameter (RVI) and left vertical Tei index changes. Meanwhile, each parameter change was mediated by ultrasound detection from before, to 30min, 6h, 12h, 36h, 48h after of CRRT to sustain liquid balance in observe group, however, central venous pressure (CVP) change was modulated in control group. The difference of kidney length in pre-CRRT were examined to exclude, and of renal aortic diameter, renal resistance index (RRI)and renal blood flow in post-48h of CRRT were compared in two groups. Results Renal length, Renal parenchyma thickness and Echo strength of renal parenchyma weren't different statistically in pre-CRRT of two groups(P>0.05). In observe group, the RVI level was started to increase significantly and IVC internal diameter to decrease at 6h, which would tend to stable at 36h(F=27.746 and 15.446 respectively);the TAPSE level was gradual ascending and Tei index was descending at 12h with a stable tendency at 24h of CRRT(F=36.213 and 17.127 respectively), and there was difference statistical among time of obvious change in TAPSE, IVC internal diameter, RVI and Tei index(P<0.05);In control group, there was no difference statistical among each time in CVP(F=2.189, P>0.05). Compared with control group, renal aortic diameter and renal blood flow were increased significantly(t=2.356 and 2.075), RRI was decreased obviously in observe group(t=2.244), which was different in statistics (P<0.05). Conclusion the application of bedside ultrasound technique in AKI patient's capacity management with CRRT was more effective and evaluated the kidney perfusion.

血清FGF-2、FGF-23与脓毒症合并急性肾损伤CRRT治疗患者肾功能及预后的关系

目的 分析血清成纤维细胞生长因子(fibroblast growth factor,FGF)-2、FGF-23与接受连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)的脓毒症合并急性肾损伤(acute kidney injury,AKI)患者肾功能和短期预后的关系。方法 选取157例接受CRRT治疗的脓毒症合并AKI患者,比较不同AKI分期患者血清FGF-2、FGF-23水平。根据28天预后情况将其分为生存组和死亡组,比较2组血清FGF-2、FGF-23及肾功能指标水平,并分析其相关性。分析血清FGF-2、FGF-23水平对短期预后的预测价值。结果 AKIⅢ期患者血清FGF-2水平低于AKIⅡ期,血清FGF-23水平高于AKIⅡ期(t=20.149、-8.060,均P<0.001)。死亡组血清FGF-23、肌酐(Scr)、胱抑素C(Cyc-C)水平高于生存组(t=-12.051、-17.462、-5.881,均P<0.001),血清FGF-2、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)低于生存组(t=25.990、15.997,均P<0.001)。Pearson分析显示血清FGF-2与Scr、Cyc-C均呈负相关(r=-0.511、-0.449,P<0.001、0.002),与eGFR呈正相关(r=0.606,P<0.001)。血清FGF-23与Scr、Cyc-C均呈正相关,与eGFR呈负相关(r=0.610、0.522、-0.654,均P<0.001)。FGF-2、FGF-23联合应用的预测价值高于两指标单独应用(Z=2.120、2.034,P=0.034、0.042)。结论 脓毒症合并AKI患者的血清FGF-2水平明显降低、FGF-23水平明显升高,且与患者肾功能下降及短期预后不良有关,二者联合检测对预测脓毒症合并AKI短期预后的价值较高。

CRRT启动时机对脓毒症性急性肾损伤患者28 d累积生存率的影响

【目的】探讨连续性肾脏替代治疗(CRRT)启动时机对脓毒症性急性肾损伤(SI-AKI)患者28 d累积生存率的影响。【方法】纳入本院重症监护室(ICU)收治的SI-AKI患者144例,随机分为早期CRRT组及对照组,每组72例。比较两组患者临床资料、治疗方案及28 d累积生存率;比较两组患者治疗前后炎症指标及肾功能指标的变化;早期CRRT对患者28 d累积生存率的影响。【结果】早期CRRT组患者非机械通气时间长于对照组(P<0.05)。治疗前,两组患者各项指标比较,差异均无统计学意义(P>0.05);治疗后,两组各项炎症指标,包括降钙素原(PCT)、C反应蛋白(CRP)、WBC、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及肾功能指标,包括血肌酐(Scr)、血尿素氮(BUN)、乳酸较治疗前均显著下降(P<0.05),且早期CRRT组PCT、CRP、IL-6、Scr、BUN的下降幅度显著大于对照组(P<0.05)。Kaplan-Meier生存分析提示,早期CRRT组患者28 d累积生存率显著高于对照组(P<0.05)。【结论】早期启动CRRT可以提高SI-AKI患者的28 d累积生存率,改善患者临床预后。