液体过负荷对脓毒症相关性AKI接受CRRT患者主要肾脏不良事件的影响

目的探讨液体过负荷（FO）对脓毒症相关性急性肾损伤（septic AKI）接受持续性肾替代治疗（CRRT）患者主要肾脏不良事件（MAKE）的影响。 方法对首都医科大学附属北京友谊医院重症医学科2015年1月至2019年6月收治的septic AKI接受CRRT的223例患者的临床资料进行回顾性分析，根据患者FO分为2组（FO＞5%和FO≤5%），收集CRRT启动时患者的人口学特征，肌酐基线值，临床基本资料，合并症，实验室数据，ICU到CRRT时间，CRRT启动前24 h内尿量以及疾病严重程度评估，入院到CRRT启动时累计液体平衡。应用logistic回归分析观察FO是否是此类患者发生MAKE的独立危险因素。 结果223例接受CRRT的脓毒性AKI患者的MAKE发生率为72.1%；FO＞5%的患者28 d MAKE发生率明显高于FO≤5%的患者，差异有统计学意义（88.3% vs 60.2%，P＜0.001）。调整混杂因素的二元logistic回归显示FO＞5%的患者与发生MAKE风险独立相关（OR=4.680，95%CI：1.990~11.006，P＜0.001）。 结论在接受CRRT的septic AKI危重患者中，FO＞5%与MAKE风险增加独立相关。

Impact of fluid overload on major adverse kidney events in critically ill patients with septic acute kidney injury requiring continuous renal replacement therapy

ObjectiveTo examine the impact of fluid overload (FO) on major adverse kidney events (MAKE) in critically ill patients with septic acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). MethodsThis was a retrospective cohort study of patients with septic AKI treated with CRRT between January 2015 and June 2019 in Beijing Friendship Hospital, Capital Medical University. The patients were divided into two groups based on the fluid overload (fluid overload greater than 5% and fluid overload less than or equal to 5%). The demographic characteristics of patients at CRRT initiation, creatinine baseline values, basic clinical data, comorbidities, laboratory data, ICU to CRRT time, urine volume within 24 h before CRRT initiation, and disease severity assessment, and cumulative fluid balance from admission to CRRT initiation were collected. Multivariable logistic regression analysis was used to determine the risk factors of MAKE. ResultsA total of 223 patients were enrolled, the occurrence rate of MAKE was 71.2%. Patients with fluid overload greater than 5% were more likely to experience 28-day major adverse kidney events than those with fluid overload less than or equal to 5% (88.3% vs 60.2%, P＜0.001). Binary logistic regression adjusted for confounders showed that fluid overload greater than 5% was found to be independently associated with MAKE. ConclusionIn critically ill patients with septic AKI requiring continuous renal replacement therapy, greater than 5% fluid overload is associated with higher risk of 28-day major adverse kidney events, including mortality and decreased renal recovery.