合并巨大左心室的心脏瓣膜病患者术后发生急性肾损伤的危险因素分析

目的 探讨合并巨大左心室的心脏瓣膜病患者心脏瓣膜术后发生急性肾损伤(AKI)的危险因素。方法 回顾性分析2018-01—2020-12在阜外华中心血管病医院行心脏瓣膜手术且合并巨大左心室的心脏瓣膜病患者的临床资料，根据术后是否发生AKI,分为AKI组和非AKI组。比较2组患者的基线、术中和术后资料。将单因素分析中P<0.2的变量放入多因素Logistic回归方程中，分析AKI与各因素的相关性。随后将连续型变量放入构建的回归模型中进行趋势性检验，进一步分析连续型变量对AKI的影响。结果 研究共纳入132例合并巨大左心室的心脏瓣膜病患者，年龄(52.9±12.5)岁；28例于术后发生AKI,非AKI组104例。单因素分析结果显示，合并糖尿病、合并脑血管疾病、围术期输血、主动脉阻断时间、体外循环时间等项目的差异有统计学意义(P<0.05)。多因素Logistic回归分析显示，基础血肌酐升高(OR=3.311,95%CI 1.086～10.096,P=0.035)、主动脉阻断时间(OR=1.022,95%CI 1.008～1.037,P=0.003)、围术期输血(OR=2.850,...     

心脏移植术后急性肾损伤的危险因素及预后分析

目的探讨心脏移植术后急性肾损伤(acute kidney injury, AKI)的危险因素及其对受者预后的影响。方法回顾性分析2018年4月至2022年11月于郑州市第七人民医院心脏移植中心行心脏移植手术180例受者的临床资料。根据术后7 d是否发生AKI, 将受者分为无AKI组(85例)和AKI组(95例), 用卡方检验、秩和检验分析比较两组受者的基线资料、围手术期一般情况及临床资料, 明确心脏移植术后发生AKI可能的影响因素;通过二元logistic回归确定独立危险因素;采用Kaplan-Meier法绘制生存曲线进一步明确AKI对心脏移植受者存活和累积住院的影响。结果本研究180例受者的移植术后AKI发生率是52.7%(95/180)。单因素分析显示AKI组受者年龄、术前白蛋白、血小板计数、移植物冷缺血时间、手术时间与无AKI组比较, 差异均有统计学意义(均P<0.05)。进一步多因素分析显示, 受者年龄(OR=1.021, 95%CI:1.001～1.043, P=0.043)、手术时间(OR=1.005, 95%CI:1.001～1.008, P=0.005)、血小板计...     

DCD供肝肝移植术后早期急性肾损伤相关危险因素分析

目的分析心脏死亡器官捐献(DCD)供肝肝移植术后早期急性肾损伤(AKI)的相关危险因素。方法回顾性分析184例DCD供肝肝移植供、受体资料。根据术后早期是否发生AKI分为AKI组和非AKI组,并且对AKI组行AKI分期。比较两组一般资料和术前、术中、术后相关指标的差异。用Kaplan-Meier曲线分析非AKI组和AKI组不同分期累积存活率等预后情况。结果本研究纳入病例184例,术后早期发生AKI 68例(37.0%),其中AKI 1期31例,AKI 2期26例,AKI 3期11例,且发生多在术后3 d内。单因素分析结果显示术前白蛋白35 g/L、术前血清钠≤137 mmol/L、手术时间7.5 h、术中出血量3 000 m L、术中红细胞输注量15 U、术中尿量≤100 m L/h这6项指标为肝移植术后早期发生AKI的危险因素(均为P0.05)。Logistic多变量回归分析结果表明术中红细胞输注量15 U是肝移植术后早期发生AKI的独立危险因素[比值比(OR)1.061,95%可信区间(CI)1.008~1.118,P=0.024]。Kaplan-Meier生存曲线结果表明随着AKI程度不断加重,其累积存活率逐渐降低,差异有统计学意义(均为P0.05)。结论肝移植患者术后早期AKI的发生率较高,且严重程度与受体的短期和长期预后密切相关,术中大量输注红细胞是AKI发生的独立危险因素。     

非体外循环下冠状动脉旁路移植术后急性肾损伤危险因素分析

目的 分析出非体外循环下行冠状动脉旁路移植术后早期发生急性肾损伤的单因素和多因素危险因子.方法 分析2011年1月-2013年12月在非体外循环下行冠状动脉旁路移植术261例患者的临床资料,根据临床诊断AKI的标准,术后发生急性肾损伤的患者29例(AKI组),男22例,女7例,平均年龄(68.74±10.27)岁;未发生急性肾损伤的患者232例(非AKI组),男179例,女53例,平均年龄(66.26±9.82)岁.总结术前血压、左心室射血分数(LVEF)、左心室内径、血肌酐及术后并发症等,利用SPSS统计软件对急性肾损伤有关的因素进行Logistic回归分析.结果 全组AKI发病率为11.11％(29/261),住院死亡1例.统计学分析结果显示,术前血肌酐含量、麻醉时间、围术期输血是导致冠状动脉旁路移植术后发生AKI的危险因素.结论 AKI是冠状动脉旁路移植术后常见的并发症,术前应认真评估危险因素,加强肾功能保护才能降低AKI发生的风险.     

急性肾损伤2期与3期连续肾脏替代治疗对危重急性肾损伤患者预后的影响比较

目的比较急性肾损伤(AKI)2期与AKI 3期连续肾脏替代治疗(CRRT)对危重AKI患者预后的影响。方法以2017年2月至2018年10月在本院ICU实施CRRT的56例危重AKI 2~3期患者为研究对象,按照2012年国际改善全球肾脏病预后组织(KDIGO)制订的新的AKI标准,将患者分为AKI 2期组(26例)与AKI 3期组(30例)。比较两组的预后指标(住院时间、CRRT持续时间、28 d肾功能恢复率、28 d全因病死率)及治疗前后的急性生理学和慢性健康状况Ⅱ(APACEⅡ)评分,采用Kaplan-Meier法对两组进行生存分析。结果AKI 3期组患者的CRRT持续时间[(188.6±112.5)h vs.(96.3±44.7)h]、28 d全因病死率[66.7%(20/30)vs.15.4%(4/26)]均明显高于AKI 2期组(P<0.05),28 d肾功能恢复率[36.7%(11/30)vs.92.3%(24/26)]均明显低于AKI 2期组(P<0.05);治疗后,两组患者APACEⅡ评分均明显降低(P<0.05),AKI 3期组患者的APACEⅡ评分[(23.4±3.6)分vs.(19.8±2.1)分]明显高于AKI 2期组(P<0.05);AKI 3期组患者的生存中位时间(34 d vs.109 d)明显短于AKI 2期组(P<0.05)。结论AKI 2期启动CRRT能够明显降低28 d全因病死率,延长生存中位时间,改善患者的健康状况。     

尿肾损伤分子-1对肺移植术后早期并发急性肾损伤患者的早期诊断

目的 探讨尿肾损伤分子-1(KIM-1)在肺移植术后急性肾损伤(AKI)中的早期诊断价值.方法 前瞻性收集本院52例肺移植手术患者在手术前后不同时相的血、尿标本,分别测定血肌酐(Scr)和尿KIM-1.根据AKI的诊断标准,将患者分为AKI组和非AKI组,观察两组Scr和尿KIM-1的动态变化.用受试者工作特征曲线(ROC)评价尿KIM-1对AKI的诊断作用.结果 52例患者中,术后发生AKI的有19例,发生率为36.5％.AKI组Scr在术后的第24h上升至基础值的1.80倍,达到AKI的诊断标准.AKI组术后4h尿KIM-1较基线值明显上升[(1.7±0.6) ng/mL比(0.5±0.3)ng/mL,P＜0.05].术后4h,尿KIM-1的ROC曲线下面积为0.837,95％的可信区间为0.729～0.946,以1.6ng/mL作为AKI的诊断界限时,敏感性和特异性分别为73.7％和75.8％.结论 尿KIM-1可较Scr更早诊断肺移植术后AKI的发生.尿KIM-1可能为肺移植术后并发AKI患者的早期诊断的标记物.     

原位肝移植患者输血因素与术后早期转归的关系

目的评价原位肝移植患者输血因素(大量输血、输注储存血及无肝期输血)与术后早期转归的关系。方法回顾性选取本院2021年1月至2022年3月终末期肝病行原位肝移植术且术中输血的患者, 收集患者临床资料。根据患者术中的输血量分为大量输血组(M组, 红细胞总输注量≥10 U)和非大量输血组(NM组), 根据输注红细胞的储存时间分为新鲜血组(NS组)和储存血组(S组, 红细胞储存时间>2周), 根据无肝期是否输血分为无肝期输血组(T组)和非无肝期输血组(NT组)。采用多因素logistic回归、广义线性模型及广义线性混合模型分别分析输血因素与主要结局指标(术后肺部并发症、循环超负荷、急性肾损伤、腹腔感染、血栓形成)和次要结局指标(ICU滞留时间、术后住院时间、术后任一时点体温≥38.5 ℃、术后肝肾功能指标、凝血功能指标、血小板计数与术前的差值)的关系。结果本研究纳入患者106例。多因素logistic回归分析结果:大量输血与输注储存血是术后肺部并发症的危险因素, 大量输血是腹腔感染的危险因素, 肝功能Child-Turcotte-Pugh评分和无肝期时间是术后急性肾损伤的危险因素, Ch...     

术前抗血小板药物对冠状动脉旁路移植术患者术后出血和输血的影响

目的评估体外循环冠状动脉旁路移植术(CABG)前不同氯吡格雷和阿司匹林的暴露水平对术后出血和异体输血的影响。方法 195例择期行CABG患者,根据术前使用氯吡格雷和阿司匹林的情况均分为用药组、停药组和空白组。用药组包括术前氯吡格雷和阿司匹林停用不足7d者,停药组包括术前氯吡格雷和阿司匹林停用超过7d者,空白组包括术前未使用氯吡格雷和阿司匹林者。主要观察术后出血和输血情况,前者具体包括术后引流量、大出血发生率和二次开胸止血率,后者包括输注异体浓缩红细胞、新鲜冰冻血浆和浓缩血小板的量和率。结果用药组术后总引流量和大出血的发生率明显多于空白组(P<0.05或P<0.01)。浓缩红细胞、新鲜冰冻血浆的输注量和输注率及总输血率在用药组、停药组和空白组间均呈逐渐递减的趋势。用药组的浓缩红细胞、新鲜冰冻血浆的输注量和输注率以及总输血率均明显高于空白组(P<0.05或P<0.01),总输血率明显高于停药组(P<0.05)。三组围术期死亡率、并发症和不良事件的发生率差异无统计学意义。结论体外循环下CABG术前7d内暴露于氯吡格雷和阿司匹林的患者术后出血和异体输血明显增加。     

血清NT-proBNP浓度对新生儿心脏手术后AKI的预测价值：基于pROCK标准

目的评价血清N末端B型利钠肽前体(NT-proBNP)浓度对新生儿心脏手术后急性肾损伤(AKI)的预测价值。方法回顾性收集2017年10月至2021年5月在本院行心脏手术的110例新生儿(出生≤28 d)的围术期资料。根据优化急性肾损伤儿科参考变化值(pROCK)标准分为AKI组和非AKI组。比较2组患儿人口统计学资料、主要诊断、实验室检查、围术期管理和术后结局等指标。血清NT-proBNP浓度为术后12 h内常规测定指标。采用多因素logistic回归模型析血清NT-proBNP浓度与术后AKI的关系。绘制受试者工作特征曲线, 根据曲线下面积判断血清NT-proBNP浓度对术后AKI的预测价值。结果共纳入新生儿106例, 术后AKI发生率54.7%。2组血红蛋白浓度、红细胞压积、血清肌酐浓度和血清NT-proBNP浓度比较差异有统计学意义(P<0.05)。多因素logistic回归分析显示, 血清NT-proBNP浓度升高是新生儿心脏手后AKI的独立危险因素(比值比2.49, 95%可信区间1.18～5.23, P=0.016)。血清NT-proBNP浓度预测新生儿心脏手术后A...     

冠状动脉旁路移植术后急性肾损伤的危险因素临床分析

目的 探讨冠状动脉旁路移植术后急性肾损伤(AKI)的危险因素;明确体外循环是否是冠状动脉旁路移植术后独立危险因素.方法 根据AKI诊断标准:选择2010年9月-2013年11月在南京市第一医院行冠状动脉旁路移植术的患者209例,分为AKI组55例和非AKI组154例,通过单因素及多因素分析比较两组间可能的相关危险因素.结果 单因素分析中,AKI组中的性别(女性)、年龄、体重指数、高血压、基础血肌酐水平、心脏射血分数、冠状动脉粥样硬化数目、体外循环、主动脉球囊反博的循环支持、术后的低心排血量、乳酸水平均比非AKI组高(P＜0.05).多因素分析中,AKI组与非AKI组相比,基础血肌酐水平、心脏射血分数、体外循环、术后的低心排血量差异具有统计学意义(P＜0.05).结论 围术期的多种因素与冠状动脉旁路移植术后AKI的发生密切相关,基础血肌酐水平、心脏射血分数、体外循环、术后的低心排血量是冠状动脉旁路移植术后独立危险因素,采用非体外循环下行冠状动脉旁路移植术,有利于肾脏保护.     

The Prevalence,Risk Factors,and Prognosis of Acute Kidney Injury After Lung Transplantation: A Single-Center Cohort Study in China

PurposeThe aim of this study is to evaluate the incidence, risk factors, and prognosis of acute kidney injury (AKI) after lung transplantation (LTx).MethodsRecords of patients who underwent LTx in a single center were retrospectively reviewed. The prevalence of post-transplant AKI, the use of continuous renal replacement therapy (CRRT), and the risk factors for AKI were investigated. The effects of AKI and CRRT on short-term outcomes and long-term survival were measured.ResultsThis study included 148 patients, 67 of which developed postoperative AKI. Of these, 31 patients underwent CRRT; the percentage of cases with no AKI was 6.2%, and the percentage of cases with stage 1, 2, and 3 who used CRRT was 0%, 10%, and 86.2%, respectively. Patients with AKI had significantly higher intensive care unit mortality and in-hospital mortality. The 1-year post-LTx survival rate of patients with AKI was 47.8%, significantly lower than those without AKI (74.1%). There was no difference in 1-year survival rate of those with stage 1 and stage 2 AKI, but patients with stage 3 AKI showed the worst survival. Patients who underwent CRRT had an inferior survival outcome (9.7% vs 76.1%, P < .05). We found that higher acute physiologic assessment and chronic health evaluation (APACHE) II scores (odds ratio [OR] 1.082, P = .009) and higher intraoperative fluid balance (OR 1.001, P = .012) were independent risk factors, and female sex (OR 2.539) and pulmonary hypertension (OR 2.869) were potential risk factors for post-LTx AKI. A prediction model integration of the above factors showed a good concordance with actual risks and had a concordance index (C-index) of 0.76 (95% confidence interval [CI], 0.66-0.87).ConclusionSevere AKI requiring CRRT had a negative impact on the short-term and long-term outcomes of patients.     

The role of nafamostat mesylate in continuous renal replacement therapy among patients at high risk of bleeding

Continuous renal replacement therapy (CRRT) has emerged as the preferred dialysis modality for critically ill patients with acute kidney injury. The objectives of this retrospective study were to assess the effect of nafamostat on circuit patency of CRRT and the safety regarding bleeding complications in patients at high risk of bleeding. We conducted a retrospective study of 243 CRRT patients at high risk of bleeding. We started CRRT without anticoagulation, and nafamostat was used if hemofilter lifespan was less than 12 h. The average hemofilter lifespan was measured before and after drug infusion to evaluate the efficacy of nafamostat. The frequency and number of red blood cell (RBC) transfusions were measured to assess the safety of nafamostat. Of the 243 patients, 62 (25.5%) received nafamostat. In nafamostat group, the hemofilter lifespan was lengthened from 10.2 (7.5-13.0) h to 19.8 (12.6-26.6) h after drug infusion (p < 0.001). The hemofilter lifespan was 27.5 (17.5-38.2) h in anticoagulation-free group. The frequency of RBC transfusion during CRRT did not differ between the nafamostat group and the anticoagulation-free group (71% vs. 70%, p = NS). The median number of RBC units transfused per CRRT day was also not different between the two groups [0.7 (0.5-1.0) units/day vs. 0.7 (0.4-1.1) units/day; p = NS]. The use of nafamostat in patients at high risk of bleeding who require CRRT effectively lengthened the filter survival time without an increase in RBC transfusion. However, 74.5% of patients at high risk of bleeding maintained an acceptable CRRT hemofilter lifespan without circuit anticoagulation.     

Trends in Dialysis Modality for Individuals with Acute Kidney Injury

Backgrounds. There are no national level data on types of dialysis in use for acute kidney injury (AKI). We aimed to assess trends in dialysis modality for AKI and mortality associated with each modality from 1998 to 2005. Methods. Using data from the 5% Medicare cohort, we identified individuals with AKI requiring dialysis. Individuals with preexisting end-stage renal disease were excluded. Intermittent hemodialysis (IHD), daily intermittent hemodialysis, and continuous renal replacement therapy (CRRT) were defined using Current Procedure Terminology codes. Mortality was defined as death during 30 days after the first dialysis session. Results. Between 1998 and 2005, there were a total of 18,249 patients identified with AKI requiring renal replacement therapy. CRRT was increasingly used for AKI, with 9.9% of patients in 1998 to 18.3% by 2005. Proportion of daily dialysis decreased during this period, while use of IHD remained stable at approximately 68%. Overall 30-day mortality declined from 44.4% in 1998 to 40.2% in 2005. Crude mortality for CRRT was highest in all years (51.0–61.8%), followed by daily (38.2–49.9%) and IHD groups (35.8–43.4%). Multinomial logistic regression analysis showed that white race, presence of sepsis, atherosclerotic heart diseases, peripheral vascular diseases, dysrhythmia, gastrointestinal and liver diseases, and any year after 2000 were independently associated with higher odds of using CRRT after adjusting for other variables. Conclusion. The proportion of patients using CRRT has increased over time. Mortality associated with IHD has decreased from 1998 to 2005. Mortality associated with different dialysis modalities is likely the result of severity of illness.     

超声造影对急性肾损伤治疗后肾血流灌注水平的评价

目的 本研究旨在通过超声造影（CEUS）评估脓毒症性急性肾损伤（SAKI）患者连续性肾脏替代治疗（CRRT）前后肾脏微循环灌注量,探讨其在SAKI患者CRRT后肾脏血流灌注水平的诊断价值。方法 选择2020年3月至2021年3月东莞市滨海湾中心医院重症医学科脓毒症患者77例作为研究对象。研究分为非AKI和SAKI两组,其中非AKI患者35例和SAKI患者42例,而SAKI组中分为CRRT与未行CRRT两组,而根据CRRT后肾功能恢复情况再分肾功能好转组和未好转组。所有研究对象均通过超声造影动态分析获取肾脏造影参数：峰值强度（PI）、达峰时间（TTP）、曲线下面积（AUC）。结果 SAKI组与非AKI组对比PI减弱、TTP延长、AUC减少（P均<0.05）,SKAI组CRRT后对比CRRT前PI增强、TTP缩短、AUC增加（P均<0.05）,SKAI组CRRT后肾功能好转组和未好转组比较,PI增强、TTP缩短、AUC增加（P均<0.05）。SAKI组中经CRRT后肾功能好转组和非AKI组比较,PI、TTP、AUC差异均无统计学意义（P>0.05）。结论肾脏超声造影...     

Value of serum bicarbonate in prediction of the long-term prognosis of renal function after acute kidney injury

Objective To evaluate the value of serum bicarbonate concentration as a prognostic indicator of renal function by following up the renal function in the acute kidney injury (AKI) patients. Methods 169 cases of AKI patients were enrolled in the study. Clinical data were collected prospectively. Risk factors of the renal outcome were evaluated. The patients were followed up for average 19 months. Results The serum bicarbonate concentration on AKI (r=-0.302, P＜0.001), 3 months after AKI (r=-0.363, P＜0.363), and 6 months after AKI (r=-0.591, P＜0.001) were all negatively correlated with serum creatinine. Compared with renal function recovered group, the serum bicarbonate concentration of renal function unrecovered group on AKI (21.92 mol/L vs 24.58mol/L), 3 months after AKI (22.58 mol/L vs 25.54 mol/L), 6 months after AKI (21.89 mol/L vs 25.42 mol/L), 12 months after AKI (19.85 mol/L vs 24.07 mol/L) were all significantly decreased (all P＜0.05). When AKI occurred, the Scr, serum bicarbonate concentration, the combined value of Scr and serum bicarbonate concentration to predict prognosis of kidney, area under the receiver-operating characteristic (ROC) curves were 0.840, 0.667, 0.837, sensitivity were 68.6%, 51%, 80.4%, specificity were 88.9%, 80.9% and 73.6%, respectively. 3 months AKI after, the Scr, serum bicarbonate concentration, the combined value of Scr and serum bicarbonate concentration to predict prognosis of kidney, area under the ROC curves were 0.838, 0.732, 0.848, sensitivity was 83.3%、 69.2%、91.7%, specificity were 79.5%, 70.8% and 74.4%, respectively. 6 months the after AKI, Scr, serum bicarbonate concentration, the combined value of Scr and serum bicarbonate concentration to predict prognosis of kidney, area under the ROC curves were 0.948, 0.798, 0.952, sensitivity were 100%, 80%, 100%, specificity were 84%, 80% and 88%, respectively. Combined 3 time points of serum bicarbonate concentration when AKI occurred, 3 month and 6 months after AKI, the area under the ROC curve was 0.850, sensitivity was 85.7%, specificity was 84.2%. When combined 3 time points of the Scr levels of AKI occurred, 3 months and 6 months after AKI, area under the ROC curve was 0.940, sensitivity was 100%, specificity was 84.2%.When combined 3 time points of combined value of Scr levels and serum bicarbonate concentrations of AKI occurred, 3 months and 6 months after AKI, the area under the ROC curve was 0.962, sensitivity was 100% and specificity was 94.7%. The Kaplan-Meier survival curve analysis showed that the serum bicarbonate concentration on AKI＜21.65 mmol/L, serum bicarbonate concentration 3 months after AKI＜24.3 mmol/L or serum bicarbonate concentration 6 months after AKI＜23.5 mmol/L were all significantly correlated with poor renal prognosis. Conclusion Serum bicarbonate concentration is helpful to predict the renal ont come after AKI. Combination of serum bicarbonate concentrations and serum creatinine levels increased the accuracy of prediction.     

Preoperative evaluation of acute renal injury after hepatectomy

Objective To explore the risk factors of post-hepatectomy acute kidney injury(AKI), a Nomogram predictive model of secondary AKI after hepatectomy was established which can provide guidance for the selection of clinically relevant treatment plans and improve the prognosis of surgical patients. Methods A total of 2769 patients who underwent hepatectomy in the Affiliated Hospital of Qingdao University from October 2012 to July 2018 were included in the study. The post-hepatectomy AKI was diagnosed according to the KDIGO AKI criteria in 2012. The selected patients were divided into AKI group (n=133) and non-AKI group (n=2636); they were divided into training group (n=2050) and test group (n=719) according to Enrollment time. The differences of preoperative clinical data, length of hospital stay, and in-hospital mortality between patients with AKI and non-AKI group were compared. The risk factors of post-hepatectomy AKI were evaluated by the Cox regression. A Nomogram predictive model of AKI after hepatectomy was established, and receiver operating curve (ROC) and consistency curve were used to verify the accuracy of the predictive model. Results The incidence of AKI after hepatectomy was 4.80%(133/2769). Compared with non-AKI group, preoperative serum albumin, hemoglobin, and hematocrit levels were lower in AKI group; the level of blood transaminase, total bilirubin, alkaline phosphatase, triglyceride, lactate dehydrogenase, and fibrinogen were higher (P＜0.050); the proportion of preoperative aspirin application was higher (P＜0.001); the duration of operation was longer (P=0.002); the proportion of open surgery was higher (P＜0.001); the mortality rate was higher (P＜0.050); the length of hospital stay was longer (P＜0.050). Cox regression results showed hypertriglyceridemia, hypoalbuminemia, alkaline phosphatase, aspartate aminotransferase, open surgery, lower preoperative glomerular filtration rate, aspirin and duration of surgery were independent risk factors for AKI. We incorporated these indicators into the Nomogram to establish a predictive model for AKI after hepatectomy, the area under ROC curve was 0.764. The area under ROC curve of the test group was 0.781. Conclusion The Nomogram predicting model of AKI after hepatectomy has high accuracy, which is helpful for prognosis of patients who underwent hepatectomy.     

Serum creatine kinase levels are not associated with an increased need for continuous renal replacement therapy in patients with acute kidney injury following rhabdomyolysis

Severe rhabdomyolysis can lead to acute kidney injury (AKI). Previous studies have reported a benefit from continuous renal replacement therapy (CRRT) for rhabdomyolysis-associated AKI. Here, we investigated the potential for serum creatine kinase (CK) levels to be used as a marker for CRRT termination in patients with AKI following rhabdomyolysis. We compared different CK levels in patients after CRRT termination and observed their clinical outcomes. We retrospectively collected 86 cases with confirmed rhabdomyolysis-associated AKI, who were receiving CRRT in Tongji Hospital. Patients’ renal functions were assessed within 24 h of intermission, patients with urine output ≥ 1,000 mL and serum creatinine ≤ 265 umol/L were considered for CRRT termination. After termination, 33 patients with a CK > 5,000 U/L were included in an experimental group, and 53 patients with a CK < 5,000 U/L were included in a control group. Clinical outcomes were compared between the two groups. Higher CK levels, as well as worse renal functions, predicted the necessity of CRRT. After CRRT termination, the in-hospital mortality (p = 0.389) and Multiple Organ Dysfunction Syndrome (MODS) incidence (p = 0.064) were similar between the two groups, while the experimental group showed a significantly shorter in-hospital length of stay (p = 0.026) and Intensive Care Unit (ICU) length of stay (p = 0.038). CRRT termination may be independent of CK levels for patients with rhabdomyolysis-associated AKI, and this is contingent on their renal functions having recovered to an appropriate level.     

Late initiation of continuous veno-venous hemofiltration therapy is associated with a lower survival rate in surgical critically ill patients with postoperative acute kidney injury

There is controversy about the appropriate timing for renal replacement therapy in patients with acute kidney injury (AKI). We are interested in the appropriate timing for initiation of continuous renal replacement therapy in critically ill surgical patients with postoperative acute kidney injury. Seventy-three critically ill surgical patients with postoperative AKI who received continuous renal replacement therapy (CRRT) were enrolled. Indications for CRRT were: 1) AKI with hyperkalemia, 2) metabolic acidosis, 3) pulmonary edema refractory to diuretics, and 4) oliguria with progressive azotemia, especially in unstable hemodynamics. Using RIFLE (Risk, Injury, Failure, Loss, End stage) classification, patients who received CRRT in the "Risk" stage were defined as early group, whereas those in the "Injury/ Failure" stage were labeled as late group. We used continuous veno-venous hemofiltration as CRRT in this series. There were 20 patients in the early group and 53 patients in the late group. The mean ages were 61.5 ± 21.8 years versus 60.8 ± 17.5 years. The mortality rate was 50 per cent versus 84.9 per cent. There were no significant differences in demographic characteristics or type of surgery or physiological scores. Our data show that late initiation of CRRT is associated with a lower survival rate in critically ill surgical patients with postoperative AKI; however, further studies are required.     

Overview of Pediatric Renal Replacement Therapy in Acute Kidney Injury

The disease spectrum leading to pediatric renal replacement therapy (RRT) provision has broadened over the last decade. In the 1980's, intrinsic renal disease and burns comprised the most common pediatric acute kidney injury (AKI) etiologies. More recent data demonstrate that pediatric AKI most often results from complications of other systemic diseases resulting from the advancements in congenital heart surgery, neonatal care, and bone marrow and solid organ transplantation. In addition, RRT modality preferences to treat critically ill children have shifted from peritoneal dialysis to continuous renal replacement therapy (CRRT) as a result of improvements in CRRT technologies. Currently, multicenter prospective outcome studies for critically ill children with AKI are sorely lacking. The aims of this paper are to review the pediatric specific causes necessitating RRT provision with an emphasis on emerging practice patterns with respect to modality and the timing of treatment, and focus upon the application of the different RRT modalities and assessment of the outcome of children with AKI who receive RRT.