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The effect of continuous renal replacement therapy for patients with sepsis
2013, 12 (12):
651-656.
doi: 10.3969/j.issn.1671-4091.2013.12.00
【Abstract】 Objective To investigate the efficacy and safety of continuous renal replacement therapy (CRRT), and the prognosis of septic patients under different therapeutic doses of CRRT. Methods A total of 53 patients (33 males and 20 females, 22-80 years old with the mean age of 62.64±14.56 years) treated with CRRT were recruited in this study. Continuous veno-venous hemofiltration (CVVHF) was used as the CRRT method. Patients were divided into two groups according to the ultrafiltration rate, CVVHF-A group (ultrafiltration rate ≥35 ml/kg/h, n=26) and CVVHF-B group (ultrafiltration rate ＜35 ml/kg/h, n=27). To evaluate the efficacy and safety of CRRT in the treatment of septic patients, we observed vital signs and blood biochemical parameters before and after CRRT, and obtained APACHE II scores before CRRT, at the fourth day during CRRT and after CRRT. To evaluate the therapeutic doses of CRRT on the prognosis of sepsis patients, survival rate and renal survival at the 15th and 30th days were compared between the two groups. Results Acute kidney injury (AKI) occurred in 49 (92.5%) of the 53 septic patients. After CRRT, body temperature, heart rate, serum K+, blood urea nitrogen, serum creatinine and white blood cells reduced significantly, pH, PO2 and HCO3- increased significantly (P＜0.05), but mean arterial pressure, serum Na+, hemoglobin, albumin and glucose remained unchanged (P>0.05). APACHE II score improved significantly at the end of CRRT (23.8±6.56 vs. 19.77±7.79, P=0.011). Ultrafiltration rate was significantly higher in CVVHF-A group than in CVVHF-B group (43.47±7.29 ml/kg/h vs. 23.90±6.30 ml/kg/h, P＜0.0001). Gender, age, chronic kidney disease, diabetes mellitus, body temperature, heart rate, mean arterial pressure, blood gas analyses, renal function, routine blood examinations, biochemical parameters, APACHE II score and urinary output were similar (P＞0.05) between the two groups at the baseline period, but platelet was higher in CVVHF-A group than in CVVHF-B group (P=0.031). Kaplan-Meier survival analysis showed that the survival rate at 15th and 30th days was 57.7% and 42.3%, respectively, in the CVVHF-A group and was 18.5% and 14.8%, respectively, in the CVVHF-B group (log-rank test, P=0.017). However, renal survival rate was indifferent between the two groups (P=0.393). Conclusions CVVHF could remove small molecule solutes, correct metabolic acidosis, and maintain hemodynamic stability without influences on nutritional status in septic patients. CVVHF with the ultrafiltration rate of >35 ml/kg/h may improve the prognosis of septic patients.
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