Early initiation renal replacement therapy for fluid management to reduce central venous pressure is more conducive to renal function recovery in patients with acute kidney injury

作     者：Zhi-Qun Xing Da-Wei Liu Xiao-Ting Wang Yun Long Hong-Min Zhang Pan Pan Long-Xiang Su Xing Zhi-Qun;Liu Da-Wei;Wang Xiao-Ting;Long Yun;Zhang Hong-Min;Pan Pan;Su Long-Xiang

作者机构：Department of Critical Care Medicine Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Beijing 100730 China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2019年第132卷第11期

页      面：1328-1335页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

主　　题：Sepsis Acute kidney injury Renal replacement therapy Central venous pressure 

摘      要：Background:Acute kidney injury (AKI) is a serious complication in critically ill patients with septic shock treated in the intensive care unit. Renal replacement therapy (RRT) is a treatment for severe AKI;however, the time of initiation of RRT and factors that affect the recovery of kidney function remains unclear. This study was to explore whether early initiation of RRT treatment for fluid management to reduce central venous pressure (CVP) can help to improve patients5 kidney function recovery. Methods: A retrospective analysis of septic patients who had received RRT treatment was conducted. Patients received RRT either within 12 h after they met the diagnostic criteria of renal failure (early initiation) or after a delay of 48 h if renal recovery had not occurred (delayed initiation). Parameters such as patients5 renal function recovery at discharge, fluid balance, and levels of CVP were assessed. Results: A total of 141 patients were eligible for enrolment: 40.4% of the patients were in the early initiation group (57 of 141 patients), and 59.6% were in the delayed initiation group (84 of 141 patients). There were no significant differences in the characteristics at baseline between the two groups, and there were no differences in 28-day mortality between the two groups (χ^2 = 2.142, P = 0.143);however, there was a significant difference in the recovery rate of renal function between the two groups at discharge (χ^2 = 4.730, P 0.001). More importantly, early initiation of RRT treatment and dehydration to reduce CVP are more conducive to the recovery of renal function in patients with AKI. Conclusion: Compared with those who received delayed initiation RRT, patients who received early-initiation RRT for dehydration to reduce CVP have enhanced kidney function recovery.