(精编)【持续性肾脏替代治疗CRRT英文精品课件】CRRT and AKI (新英格兰杂志).pptVIP

Background AKI 2 - 7% of hospitalized patients 35 % of ICU patients RRT in 5 – 6% of ICU patients Morbidity and mortality rates 50% Background RRT in AKI When to start? What dose? What method? Background BUN = 104 60 Background Background Objectives Test the hypothesis More intensive RRT is associated with improved survival in ICU patients with AKI Methods Eligible Patients Critically ill 18 yrs or older AKI consistent with ATN, and requiring RRT Failure of one or more other organs, or sepsis No more than 1 IHD or SLED prior to randomization 24 hrs of CRRT prior to randomization Methods Randomization SOFA cardiovascular score Oliguria ( 20 ml/hr for 24 hrs) SOFA Cardiovascular MAP 70 mm/Hg, 1 dopamine = 5 or dobutamine (any dose), 2 dop 5 OR epi = 0.1 OR nor = 0.1, 3 dop 15 OR epi 0.1 OR nor 0.1, 4 (vasopressor drug doses are in mcg/kg/min) Methods Interventions SOFA cardiovascular score of 0 - 2 received IHD SOFA cardiovascular score of 3 – 4 received SLED or CRRT (site specific) Transition based on CV status Methods Intensive therapy 6 IHD or SLED per week (spKt/v 1.2 to 1.4) CVVHDF with 35 ml/kg/hr of effluent “Standard” therapy 3 IHD or SLED per week CVVHDF with 20 ml/kg/hr of effluent Additional UF was allowed Methods Assigned RRT was provided for up to 28 days post randomization, unless Recovery of renal fxn Discharge from acute care Withdrawal of care Death Methods Primary end point All cause mortality at 60 days Secondary end points In-hospital death Recovery of kidney function Additional end points Duration of RRT Length of ICU stay Days free of non-renal organ failure Pt returned to ‘home’ Conclusion There was no difference in 60 day mortality or rate of recovery of renal function between the two groups. Intensive therapy resulted in more episodes of hypotension and electrolyte abnormalities Discussion Multicenter, randomized, prospective Study design consistent with clinical practice Discussion More SLED in the high inte