■连续肾脏替代疗法(CKRT)是急性肾脏替代疗法的主要形式,用于患有急性肾损伤(AKI)的危重成人患者。鉴于CKRT实践中的可变性,对其流行病学的当代理解对于改善护理服务是必要的。
■多中心,前瞻性生活登记处。
■1,106名患有AKI的重症患者,从2013年12月到2021年1月,在5个学术中心和6个重症监护病房需要CKRT。先前存在肾衰竭的患者和冠状病毒2感染的患者被排除在外。
■CKRT超过24小时。
■医院死亡率,肾脏恢复,和医疗资源利用。
■根据重症监护病房入院和CKRT开始时的预选时间点收集数据,并进行描述性分析。
■患者特征,AKI的贡献者,CKRT的适应症在各中心不同。平均(标准差)年龄为59.3(13.9)岁,39.7%的患者是女性,中位[IQR]APACHE-II(急性生理评估和慢性健康评估)评分为30分[25-34].总的来说,41.1%的患者存活到出院。死亡的患者年龄较大(平均年龄61岁vs.56.8,P<0.001),合并症更大(Charlson评分中位数3[1-4]vs.2[1-3],P<0.001),和更高的疾病敏锐度(APACHE-II评分中位数30[25-35]vs.29[24-33],P=0.003)。AKI最常见的诱因是败血症(42.6%),最常见的CKRT指征是少尿/无尿(56.2%)和液体超负荷(53.9%)。各中心的标准化死亡率相似。
■这些结果在非学术中心或中低收入国家的CKRT实践中的普适性是有限的。
■在此注册表中,脓毒症是AKI的主要原因,液体管理是最常见的CKRT适应症.在目前的实践中发现了患者和CKRT特异性特征的显着异质性。这些数据凸显了建立CKRT交付基准的必要性,性能,和患者结果。来自该注册表的数据可以帮助设计此类研究。
UNASSIGNED: Continuous kidney replacement therapy (
CKRT) is the predominant form of acute kidney replacement therapy used for critically ill adult patients with acute kidney injury (AKI). Given the variability in
CKRT practice, a contemporary understanding of its epidemiology is necessary to improve care delivery.
UNASSIGNED: Multicenter, prospective living registry.
UNASSIGNED: 1,106 critically ill adults with AKI requiring
CKRT from December 2013 to January 2021 across 5 academic centers and 6 intensive care units. Patients with pre-existing kidney failure and those with coronavirus 2 infection were excluded.
UNASSIGNED: CKRT for more than 24 hours.
UNASSIGNED: Hospital mortality, kidney recovery, and health care resource utilization.
UNASSIGNED: Data were collected according to preselected timepoints at intensive care unit admission and CKRT initiation and analyzed descriptively.
UNASSIGNED: Patients\' characteristics, contributors to AKI, and
CKRT indications differed among centers. Mean (standard deviation) age was 59.3 (13.9) years, 39.7% of patients were women, and median [IQR] APACHE-II (acute physiologic assessment and chronic health evaluation) score was 30 [25-34]. Overall, 41.1% of patients survived to hospital discharge. Patients that died were older (mean age 61 vs. 56.8, P < 0.001), had greater comorbidity (median Charlson score 3 [1-4] vs. 2 [1-3], P < 0.001), and higher acuity of illness (median APACHE-II score 30 [25-35] vs. 29 [24-33], P = 0.003). The most common condition predisposing to AKI was sepsis (42.6%), and the most common CKRT indications were oliguria/anuria (56.2%) and fluid overload (53.9%). Standardized mortality ratios were similar among centers.
UNASSIGNED: The generalizability of these results to CKRT practices in nonacademic centers or low-and middle-income countries is limited.
UNASSIGNED: In this registry, sepsis was the major contributor to AKI and fluid management was collectively the most common CKRT indication. Significant heterogeneity in patient- and CKRT-specific characteristics was found in current practice. These data highlight the need for establishing benchmarks of CKRT delivery, performance, and patient outcomes. Data from this registry could assist with the design of such studies.