影响急性肾损伤重危患者预后的因素英文医学ppt课件.ppt

Factors Influencing the Outcome of Critically Ill Patients with Acute Kidney Injury William R. Clark, M.D. Indiana University School of Medicine Indianapolis, Indiana USA Effect of dialysis modality on renal recovery in acute kidney injury (AKI) Critical importance of underlying CKD Effect of ICU dialysis modality on renal recovery Health economic implications for renal recovery after ARF Timing of diagnosis and treatment in AKI Timely diagnosis: the RIFLE criteria Clinical studies assessing effect of timing of dialysis initiation on patient outcome Approximately 30,000 patients from 54 hospitals in 23 countries (including US) 6% of all ICU admissions developed ARF Of these patients, approximately 70% required dialysis 30% of patients had renal impairment prior to development of ARF 13% of patients were dialysis-dependent at discharge CRRT was initial dialysis modality in 80% of patients Hospital mortality of 60% Progression to ESRD following ARFby CKD Status Progression to ESRD following ARF by Agein CKD Patients Characteristics of study 2,022 patients across 32 Swedish hospitals Modality breakdown: CRRT - 86%; IHD - 14% Dependence on chronic dialysis at 90 days differed significantly between the two modalities CRRT – 8%; IHD – 17% For those patients who developed ESRD, long-term risk of death also differed significantly IHD:CRRT odds ratio for death was 2.29 Odds Ratio for ESRD Development After ARF Treated with IHD or CRRTBell et al, Intensive Care Med 2007 Survival Comparison After ARF Treated with CRRT or IHDBell et al, Intensive Care Med 2007 CRRT vs. IHD for Renal RecoveryManns et al, Crit Care Med 2003 Mehta et al (2002) 17% of IHD patients vs 4% of CRRT patients had CKD at hospital discharge or death (intent-to-treat; P=0.01) 92% vs 59% of patients receiving adequate trial of monotherapy (CRRT vs IHD, respectively; P0.01) had complete recovery of renal function Patients crossing over from IHD to CRRT had signi