中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (08): 659-665.doi: 10.3969/j.issn.1671-4091.2025.08.008

• 临床研究 • 上一篇    下一篇

净超滤率与接受连续性肾脏替代治疗的急性肾损伤患者预后的关系

陆敬雁    贾新燕   马 潇   

  1. 730000 兰州，1兰州市第一人民医院肾病内科
  • 收稿日期:2025-01-21 修回日期:2025-05-14 出版日期:2025-08-12 发布日期:2025-08-12
  • 通讯作者: 陆敬雁 E-mail:lujingyany6@163.com
  • 基金资助:
    甘肃省卫生健康行业科研计划项目(GSWSKY2020-08)

Relationship between net ultrafiltration rate and prognosis in patients with acute kidney injury treated with continuous renal replacement: using the propensity score matching method

LU Jing-yan, JIA Xin-yan, MA Xiao   

  1. Department of Nephrology, The First People's Hospital of Lanzhou, Lanzhou 730000,China
  • Received:2025-01-21 Revised:2025-05-14 Online:2025-08-12 Published:2025-08-12
  • Contact: 730000 兰州，1兰州市第一人民医院肾病内科 E-mail:lujingyany6@163.com

摘要： 目的 基于倾向性评分匹配法(propensity score matching，PSM)探讨净超滤率(net ultrafiltration rate，UFNET)与接受连续性肾脏替代治疗(continuous renal replacement therapy，CRRT)的急性肾损伤(acute kidney injury，AKI)患者预后的关系。 方法 回顾性分析2020年2月—2024年2月兰州市第一人民医院收治的接受CRRT的AKI患者临床资料，统计住院28 d内患者存活情况。记录CRRT期间UFNET值，受试者工作特征(receiver operating characteristrc,ROC)曲线确定UFNET预测接受CRRT的AKI患者住院28 d内死亡的临界值。采用PSM均衡高UFNET组低UFNET组间的混杂因素，按1：1匹配，比较PSM后2组患者住院28 d内的死亡率，COX回归分析UFNET与接受CRRT的AKI患者住院28 d内死亡的关系。 结果 共纳入162例接受CRRT的AKI患者，其中住院28 d内死亡68例(41.98%)，UFNET预测AKI患者住院28 d死亡的临界值为1.51 ml/(kg·h)，根据UFNET临界值将患者分为高UFNET组(78例)和低UFNET组(84例)。PSM前高UFNET组AKI分期Ⅲ期、入院时牛津急性疾病严重程度评分(oxford acute severity of illness score，OASIS)、入院时序贯器官衰竭评估评分(sequential organ failure assessment score，SOFA)、机械通气、最高尿素氮、最高血肌酐(serum crea tinine,Scr)高于低UFNET组(t/χ2值分别为6.228、4.671、10.850、8.414、7.366、9.253，P值分别为0.013、＜0.001、＜0.001、0.004、＜0.001、＜0.001)，最低pH值、最低碱剩余、最低估算肾小球滤过率(estimated glomerular filtration rate，eGFR)低于低UFNET组(t值分别为4.692、12.553、5.790，均P＜0.001)。PSM匹配92例AKI患者，PSM后2组间变量分布均衡(P＞0.05)。高UFNET组住院28天死亡率高于低UFNET组(52.17%比26.09%，log-rank c2=6.324，P＜0.001)。COX回归分析显示高UFNET组发生住院28 d死亡的风险是低UFNET组的2.123倍(HR=2.123，95% CI：1.152～3.914，P＜0.001)。 结论 高UFNET与接受CRRT的AKI患者住院28 d内死亡有关。

关键词: 急性肾损伤, 连续性肾脏替代治疗, 液体超负荷, 净超滤率

Abstract: Objective  To investigate the relationship between net ultrafiltration rate (UFNET) and prognosis of the patients with acute kidney injury (AKI) receiving continuous renal replacement therapy (CRRT) based on the propensity score matching method (PSM).  Methods  Clinical data of 162 AKI patients treated with CRRT in The First People's Hospital of Lanzhou from February 2020 to February 2024 were retrospectively analyzed. The survival rate within 28 days of hospitalization was analyzed. UFNET value was recorded during CRRT. Receiver operating characteristic (ROC) curve was used to determine the cut-off UFNET value to predict death within 28 days of hospitalization in AKI patients receiving CRRT. PSM was used to balance the confounding factors between high UFNET group and low UFNET group, and the mortality rate within 28 days of hospitalization after PSM was compared by 1:1 matching. Univariate Cox regression was used to analyze the relationship between UFNET and 28-day death in AKI patients receiving CRRT.   Results  Among the 162 AKI patients treated with CRRT, 68 (41.98%) died within 28 days in hospital. The cut-off UFNET value to predict the death rate within 28 days of hospitalization in AKI patients was 1.51 ml/(kg·h).  Patients were divided into high UFNET group (78 cases) and low UFNET group (84 cases) according to the cut-off UFNET value. Before PSM, the proportion of patients with the Acute Kidney Injury stage Ⅲ (57.69% vs. 38.10%), the Oxford Acute Severity of Illness Score (OASIS) at admission (49.35±6.09 points vs. 45.02±5.71 points), the Sequential Organ Failure Assessment Score (SOFA) at admission (13.65±2.04 points vs. 10.08±2.14 points), the proportion of patients receiving mechanical ventilation (57.69% vs. 41.67%), the highest level of blood urea nitrogen (BUN) [(16.35±3.02)mmol/L vs. (13.09±2.61)mmol/L] and the highest level of serum creatinine (Scr) [(109.33±6.21）μmol/L vs. (101.12±5.09)μmol/L] were significantly higher in high UFNET group than in low UFNET group (t/χ²=6.228, 4.671, 10.850, 8.414, 7.366 and 9.253 respectively; P=0.013, 0.000, 0.000, 0.004, 0.000 and 0.000 respectively), while the lowest pH value (7.20±0.16 vs. 7.33±0.19), the lowest base excess [(-10.32±2.41)mmol/L vs. (-6.32±1.59)mmol/L] and the lowest estimated glomerular filtration rate (eGFR) [(60.34±6.09 ml/(min·1.73m²) vs. 66.75±7.82 ml/(min·1.73m²)] were significantly lower in high UFNET group than in low UFNET group (t=4.692, 12.553 and 5.790 respectively; P=0.000, 0.000 and 0.000 respectively). PSM matched 92 AKI patients, and the distribution of variables reached equilibrium between the two groups after PSM (P>0.05); the 28 day in-hospital mortality was higher in high UFNET group than in low UFNET group (52.17% vs. 26.09%; log-rank: χ²=6.324, P=0.000). Univariate COX regression analysis showed that the risk of 28 day in-hospital death in high UFNET group was 2.123 times higher than that in low UFNET group (HR=2.123, 95% CI: 1.152～3.914, P=0.000).   Conclusion   High UFNET is associated with death within 28 days of hospitalization in AKI patients receiving CRRT.

Key words: Acute kidney injury, Continuous renal replacement therapy, Fluid overload, Net ultrafiltration

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