Clinical analysis of continuous renal replacement therapy in patients with acute kidney injury in ICU

Abstract

Objective To investigate risk factors of the 28 d survival rate in patients with acute kidney injury after continuous renal replacement therapy (CRRT) in ICU. Methods A total of 1 720 patients with acute kidney injury treated with CRRT in ICU of the First AffiliatedHospital, College of Medicine, Zhejiang University from January 1, 2008 to December 31, 2013 were selected, and then 1 165 patients were analyzed. The patients were divided into the death group (689 cases) and the survival group (476 cases) according to the 28 d survival after CRRT treatment, and the 28 d mortality was 59.14% (689/1 165). The general data of the two groups were compared, and the risk factors for the 28 d survival rate were identified by Logistic multivariate regression analysis. Results The age ≥ 65 years, the 24 h urine volume < 400 mL, the use of mechanical ventilation, the application of vasopressors, the mean arterial pressure < 80 mmHg, the platelet count < 100 × 109/L, the bicarbonate radical < 22 mmol/L, the lactic acid ≥ 1.7 mmol/L, the total bilirubin ≥ 100 μmol/L, the serum creatinine < 250 μmol/L, the blood glucose < 3.9 mmol/L, the acute physiology and chronic health evaluation (APACHE) Ⅱ score ≥ 23 and the simplified acute physiology score (SAPS) Ⅱ ≥ 56 of patients with acute kidney injury before CRRT in these two groups were significantly different (χ2 = 10.376, 11.596, 85.674, 103.017, 86.318, 41.626, 9.862, 86.269, 30.228, 28.691, 13.664, 212.194, 232.712; all P < 0.05). Logistic regression analysis showed that the age ≥ 65 years [OR = 1.643, 95%CI (1.214, 2.224)], the mean arterial pressure < 80 mmHg [OR = 1.932, 95%CI (1.417, 2.633)], the platelet count < 100 × 109/L [OR = 1.968, 95%CI (1.467, 2.640)], the lactic acid ≥ 1.7 mmol/L [OR = 1.665, 95%CI (1.226, 2.262)], the total bilirubin ≥ 100 μmol/L [OR = 2.263, 95%CI (1.518, 3.375)], the serum creatinine < 250 μmol/L [OR = 1.733, 95%CI (1.269, 2.366)], the blood glucose < 3.9 mmol/L [OR = 3.365, 95%CI (1.282, 8.831)], the APACHEⅡ score ≥ 23 [OR = 3.233, 95%CI (2.325, 4.495)] and the SAPSⅡ score ≥ 56 [OR = 3.058, 95%CI (2.170, 4.309)] were the risk factors of 28 d survival rate in patients with acute kidney injury after CRRT in ICU (all P < 0.05). Conclusion The age ≥ 65 years, the mean arterial pressure < 80 mmHg, the platelet count < 100 × 109/L, the lactic acid ≥ 1.7 mmol/L, the total bilirubin ≥ 100 μmol/L, the serum creatinine < 250 μmol/L, the blood glucose < 3.9 mmol/L, the APACHEⅡ score ≥ 23 and the SAPSⅡ score ≥ 56 were the risk factors of the 28 d survival rate in patients with acute kidney injury after CRRT in ICU. Key words: Acute kidney injury; Continuous renal replacement therapy; ICU; Risk factors