肾脏病学与治疗学杂志

Evaluation of the Time to Terminate Continuous Renal Replacement Therapy in Patients with Acute Kidney Injury Following Cardiovascular Surgery in Association with or without a Mechanical Ventilation Support

Abstract

Isao Tsukamoto,Youhei Tsuchiya,Hiromichi Suzuki*,Yusuke Watanabe,Keita Sueyoshi,Hirokazu Okada

Acute kidney injury (AKI) is a frequent and severe complication after cardiovascular surgery. Indications for continuous renal replacement therapy (CRRT) in patients with AKI have been proposed. However, there is often less discussion of when to terminate CRRT as well as what conditions are required for transferring patients to intermittent hemodialysis (HD). In this retrospective study of electronic medical records, we examined the role of a mechanical ventilator support in determining when to terminate CRRT in patients with AKI. When CRRT was stopped, 32 patients were supported with a mechanical ventilator while 41 patients had no support. Although there were no differences in age, sex, and pre levels of cardiopulmonary between the two groups, the levels of eGFR before the cardiovascular surgery were lower in the patients without a ventilator. Increases in body weight after cardiac surgery were higher, sequential organ failure assessment (SOFA) score was higher, and central venous pressures were higher in patients supported with a ventilator (all were p<0.05). The rate of re-introduction to CRRT was higher (p=0.016) in patients supported with a ventilator. After multiple regression analysis, successful cessation of CRRT was dependent on support of mechanical ventilation (odds ratio, 5.20 (CI: 1.15-23.4)). These data suggest that successful termination of CRRT is closely associated with removing the support of a mechanical ventilator.