Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients

被引：14

作者：

Bellomo, R. ^{[24
]}

Cass, A.

Norton, R.

Gallagher, M.

Lo, S.

Su, S.

Cole, L. ^{[1
]}

Finfer, S. ^{[2
]}

McArthur, C. ^{[3
,16
]}

McGuinness, S. ^{[3
,15
]}

Myburgh, J. ^{[4
]}

Scheinkestel, C. ^{[5
]}

Bellomo, R. ^{[24
]}

Lee, J.

Ali, D.

Cass, A.

Cole, L. ^{[1
]}

Finfer, S. ^{[2
]}

Gallagher, M.

Goldsmith, D. ^{[24
]}

McGuinness, S. ^{[3
,15
]}

Myburgh, J. ^{[4
]}

Norton, R.

Scheinkestel, C. ^{[5
]}

Banerjee, A. ^{[14
]}

Bhonagiri, D. ^{[9
]}

Blythe, D. ^{[31
]}

Botha, J. ^{[26
]}

Cade, J.

Cole, L. ^{[1
]}

Dobb, G. ^{[32
]}

Eddington, J.

Finfer, S. ^{[2
]}

Flabouris, A. ^{[22
]}

French, C. ^{[30
]}

Garrett, P. ^{[19
]}

Henderson, S. ^{[17
]}

Ihle, B.

Joyce, C. ^{[20
]}

Kalkoff, M. ^{[18
]}

Lipman, J. ^{[21
]}

McArthur, C. ^{[3
,16
]}

McGuinness, S. ^{[3
,15
]}

Milliss, D.

Mitchell, I. ^{[7
]}

Morgan, J.

Myburgh, J. ^{[4
]}

Nair, P. ^{[13
]}

Orford, N. ^{[27
]}

Raza, A. ^{[6
]}

机构：

[1] Nepean Hosp, Kingswood, NSW, Australia

[2] Royal N Shore Hosp, Sydney, NSW, Australia

[3] Auckland City Hosp, Auckland, New Zealand

[4] St George Hosp Sydney, Sydney, NSW, Australia

[5] Alfred Hosp, Melbourne, Vic, Australia

[6] New S Wales Blacktown Hosp, Blacktown, NSW, Australia

[7] Australian Capital Terr Canberra Hosp, Canberra, ACT, Australia

[8] John Hunter Hosp, New Lambton Hts, NSW, Australia

[9] Liverpool Hosp, Liverpool, Merseyside, England

[10] Newcastle Mater Calvary Hosp, Newcastle, NSW, Australia

[11] Prince Wales Hosp, Sydney, NSW, Australia

[12] Royal Prince Alfred Hosp, Sydney, NSW, Australia

[13] St Vincents Hosp, Sydney, NSW, Australia

[14] Westmead Hosp, Westmead, NSW, Australia

[15] New Zealand Auckland City Hosp, Cardiovasc Intens Care Unit, Auckland, New Zealand

[16] Auckland City Hosp, Dept Crit Care Med, Auckland, New Zealand

[17] Christchurch Hosp, Christchurch, New Zealand

[18] Whangarei Hosp, Whangarei, New Zealand

[19] Nambour Gen Hosp, Nambour, Qld, Australia

[20] Princess Alexandra Hosp, Woolloongabba, Qld, Australia

[21] Royal Brisbane Hosp, Brisbane, Qld, Australia

[22] S Australia Royal Adelaide Hosp, Adelaide, SA, Australia

[23] Tasmania Royal Hobart Hosp, Hobart, Tas, Australia

[24] Victoria Austin Hosp, Melbourne, Vic, Australia

[25] Bendigo Hosp, Bendigo, Vic, Australia

[26] Frankston Hosp, Melbourne, Vic, Australia

[27] Geelong Hosp, Geelong, Vic, Australia

[28] Royal Melbourne Hosp, Melbourne, Vic, Australia

[29] St Vincents Hosp Mellbourne, Melbourne, Vic, Australia

[30] Western Hosp, Toronto, ON, Canada

[31] Western Australia Fremantle Hosp, Fremantle, WA, Australia

[32] Royal Perth Hosp, Perth, WA, Australia

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2009年 / 361卷 / 17期

基金：

英国医学研究理事会;

关键词：

ACUTE KIDNEY INJURY; RIFLE CRITERIA; FAILURE; HEMOFILTRATION; SURVIVAL; DIALYSIS; COHORT;

D O I：

暂无

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background The optimal intensity of continuous renal-replacement therapy remains unclear. We conducted a multicenter, randomized trial to compare the effect of this therapy, delivered at two different levels of intensity, on 90-day mortality among critically ill patients with acute kidney injury. Methods We randomly assigned critically ill adults with acute kidney injury to continuous renal-replacement therapy in the form of postdilution continuous venovenous hemodiafiltration with an effluent flow of either 40 ml per kilogram of body weight per hour (higher intensity) or 25 ml per kilogram per hour (lower intensity). The primary outcome measure was death within 90 days after randomization. Results Of the 1508 enrolled patients, 747 were randomly assigned to higher-intensity therapy, and 761 to lower-intensity therapy with continuous venovenous hemodiafiltration. Data on primary outcomes were available for 1464 patients (97.1%): 721 in the higher-intensity group and 743 in the lower-intensity group. The two study groups had similar baseline characteristics and received the study treatment for an average of 6.3 and 5.9 days, respectively (P = 0.35). At 90 days after randomization, 322 deaths had occurred in the higher-intensity group and 332 deaths in the lower-intensity group, for a mortality of 44.7% in each group (odds ratio, 1.00; 95% confidence interval [CI], 0.81 to 1.23; P = 0.99). At 90 days, 6.8% of survivors in the higher-intensity group (27 of 399), as compared with 4.4% of survivors in the lower-intensity group (18 of 411), were still receiving renal-replacement therapy (odds ratio, 1.59; 95% CI, 0.86 to 2.92; P = 0.14). Hypophosphatemia was more common in the higher-intensity group than in the lower-intensity group (65% vs. 54%, P< 0.001). Conclusions In critically ill patients with acute kidney injury, treatment with higher-intensity continuous renal-replacement therapy did not reduce mortality at 90 days. (ClinicalTrials.gov number, NCT00221013.)

引用

页码：1627 / 1638

页数：12

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