PDF(Pubmed)
Abstract：
Optimal strategy for volume control and the clinical implication of achieved volume control are unknown in patients with sepsis-associated acute kidney injury (AKI) receiving continuous renal replacement therapy (CRRT). This randomized controlled trial aimed to compare the survival according to conventional or bioelectrical impedance analysis (BIA)-guided volume control strategy in patients with sepsis-associated AKI receiving CRRT. We also compared patient survival according to achieved volume accumulation rate ([cumulative fluid balance during 3 days × 100]/fluid overload measured by BIA at enrollment) as a post-hoc analysis. We randomly assigned patients to conventional volume control strategy (n = 39) or to BIA-guided volume control strategy (n = 34). There were no differences in 28-day mortality (HR, 1.19; 95% CI, 0.63-2.23) or 90-day mortality (HR, 0.99; 95% CI 0.57-1.75) between conventional and BIA-guided volume control group. In the secondary analysis, achieved volume accumulation rate was significantly associated with patient survival. Compared with the achieved volume accumulation rate of ≤ - 50%, the HRs (95% CIs) for the risk of 90-day mortality were 1.21 (0.29-5.01), 0.55 (0.12-2.48), and 7.18 (1.58-32.51) in that of - 50-0%, 1-50%, and > 50%, respectively. Hence, BIA-guided volume control in patients with sepsis-associated AKI receiving CRRT did not improve patient outcomes. In the secondary analysis, achieved volume accumulation rate was associated with patient survival.
摘要：
在接受连续肾脏替代疗法（CRRT）的脓毒症相关急性肾损伤（AKI）患者中，容量控制的最佳策略和实现容量控制的临床意义尚不清楚。这项随机对照试验旨在比较接受CRRT的脓毒症相关AKI患者根据常规或生物电阻抗分析（BIA）指导的容量控制策略的生存率。作为事后分析，我们还根据已达到的体积积累率（[3天期间的累积液体平衡×100]/BIA在登记时测量的液体超负荷）比较了患者的生存率。我们将患者随机分配到常规容量控制策略（n=39）或BIA指导的容量控制策略（n=34）。28天死亡率没有差异(HR，1.19；95%CI，0.63-2.23）或90天死亡率（HR，0.99；95%CI0.57-1.75）在常规和BIA引导容量对照组之间。在次要分析中，已达到的容积累积率与患者生存率显著相关.与达到的体积积累率≤-50%相比，90天死亡率风险的HR（95%CI）为1.21（0.29-5.01），0.55（0.12-2.48），和7.18（1.58-32.51），其中-50-0%，1-50%,>50%，分别。因此，在接受CRRT的脓毒症相关AKI患者中，BIA引导的容量控制并未改善患者预后。在次要分析中，已达到的容积累积率与患者生存率相关.
