背景:患者静脉动脉体外膜氧合(VA-ECMO)的肾脏替代疗法(RRT)的最佳方式仍不清楚。这项研究旨在比较VA-ECMO患者的连续性肾脏替代治疗(CRRT)和腹膜透析(PD)的结果。
方法:此单中心回顾性研究包括发生AKI并随后需要CRRT或PD的VA-ECMO患者。患者人口统计数据,合并症,临床特征,RRT模态,并收集结果。主要结果是住院死亡率,次要结果包括住院时间,RRT持续时间,以及与RRT相关的并发症。
结果:共纳入43例患者(72.1%为男性,平均年龄58.2±15.7岁)。其中,在ECMO治疗期间,21人接受CRRT,22人接受PD。CRRT组和PD组之间的住院死亡率没有显着差异(80.9%vs90.9%,p=0.35)。然而,PD与导管相关并发症发生率较高相关,包括错位(31.8%对4.7%,p=0.046),感染(22.7%vs4.7%,p=0.19),和出血(18.2%vs9.5%,p=0.66),分别。
结论:在接受VA-ECMO支持的RRT的患者中,我们的研究显示,CRRT和PD的住院死亡率相当,尽管PD与导管相关并发症的发生率较高相关。
BACKGROUND: The optimal modality for renal replacement therapy (RRT) in patients venoarterial extracorporeal membrane oxygenation (VA-
ECMO) remains unclear. This study aimed to compare outcomes between continuous renal replacement therapy (CRRT) and peritoneal dialysis (PD) in VA-
ECMO patients.
METHODS: This single-center retrospective study included VA-
ECMO patients who developed AKI and subsequently required CRRT or PD. Data on patient demographics, comorbidities, clinical characteristics, RRT modality, and outcomes were collected. The primary outcome was in-hospital mortality, with secondary outcomes including length of stays, RRT durations, and complications associated with RRT.
RESULTS: A total of 43 patients were included (72.1% male, mean age 58.2 ± 15.7 years). Of these, 21 received CRRT and 22 received PD during
ECMO therapy. In-hospital mortality rates did not significantly differ between CRRT and PD groups (80.9% vs 90.9%, p = 0.35). However, PD was associated with a higher incidence of catheter-related complications, including malposition (31.8% vs 4.7%, p = 0.046), infection (22.7% vs 4.7%, p = 0.19), and bleeding (18.2% vs 9.5%, p = 0.66), respectively.
CONCLUSIONS: Among patients receiving VA-
ECMO-supported RRT, our study revealed comparable in-hospital mortality rates between CRRT and PD, although PD was associated with a higher incidence of catheter-related complications.