[Association between early net ultrafiltration rate and outcomes in patients with cardiac surgery-associated acute kidney injury receiving continuous renal replacement therapy]

Zhonghua Yi Xue Za Zhi. 2024 Nov 26;104(44):4057-4064. doi: 10.3760/cma.j.cn112137-20240406-00796.
[Article in Chinese]

Abstract
in English, Chinese

Objective: To evaluate the association between early net ultrafiltration (NUF) rate and risk of death in patients with cardiac surgery-associated acute kidney injury (CSA-AKI) requiring continuous renal replacement therapy (CRRT). Methods: Adult patients who received CRRT for more than 24 hours due to CSA-AKI in the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2021 were prospectively included. The NUF rate during the first 48 hours of CRRT was taken as a classified variable (low rate:<1.70 ml·kg-1·h-1; moderate rate: 1.70-2.47 ml·kg-1·h-1; high rate:>2.47 ml·kg-1·h-1). The association between 90-day mortality and NUF rates was analyzed by Cox regression and mediation analyses. Results: A total of 262 patients were enrolled (171 males and 91 females), with the median (Q1, Q3) age of 64 (54, 71) years and median (Q1, Q3) NUF rate of 2.03 (1.58, 2.62) ml·kg-1·h-1. The 90-day mortality was 60.3% (158/262). Compared with the moderate NUF rate, patients with the low NUF rate (adjusted HR=1.52, 95%CI: 1.01-2.27, P=0.043) and high NUF rate (adjusted HR=1.54, 95%CI: 1.02-2.33, P=0.039) had a significantly higher risk of 90-day death. In mediation analysis, compared with the moderate NUF rate, the putative effect of the high NUF rate on 90-day mortality was direct [adjusted average direct effects (ADE)=1.12, 95%CI: 1.04-1.21,P=0.004] and not mediated by effects of the NUF rate on fluid balance [adjusted average causal mediation effects (ACME)=1.00, 95%CI:0.98-1.01, P=0.502]. The putative effect of the low NUF rate on mortality was not direct (adjusted ADE=0.93, 95%CI:0.81-1.05, P=0.274), but was mediated by its effect on fluid balance (adjusted ACME=0.93, 95%CI:0.87-0.98, P=0.018). Conclusion: Compared with NUF rates between 1.70-2.47 ml·kg-1·h-1 within the first 48 hour of CRRT, NUF rates>2.47 and<1.70 ml·kg-1·h-1 were associated with higher mortality in CSA-AKI patients receiving CRRT.

目的： 评估连续性肾脏替代治疗（CRRT）早期净超滤（NUF）率水平是否与心脏手术相关急性肾损伤（CSA-AKI）患者的死亡风险有关。 方法： 前瞻性纳入2016年1月至2021年12月在南京医科大学第一附属医院因CSA-AKI接受CRRT超过24 h的成年患者，排除住院时间<48 h、二次心脏手术、需行血浆置换术或间歇性血液透析患者。将CRRT启动后前48 h内的NUF率作为分类变量（低：<1.70 ml·kg-1·h-1，中等：1.70~2.47 ml·kg-1·h-1，高：>2.47 ml·kg-1·h-1）。采用Cox回归模型和中介分析探索NUF率与90 d死亡的关系。 结果： 最终纳入262例患者，男171例，女91例，年龄M（Q1，Q3）为64（54，71）岁，NUF率M（Q1，Q3）为2.03（1.58，2.62）ml·kg-1·h-1，90 d死亡率60.3%（158/262）。与中等NUF率相比，低NUF率（校正HR=1.52，95%CI：1.01~2.27，P=0.043）和高NUF率（校正HR=1.54，95%CI：1.02~2.33，P=0.039）的患者90 d死亡风险均升高。在中介分析中，与中等NUF率相比，高NUF率对90 d死亡风险的假定影响是直接的［校正后的平均直接效应（ADE）=1.12，95%CI：1.04~1.21，P=0.004］，而不是由NUF率对体液平衡的影响介导［校正后的平均因果中介效应（ACME）=1.00，95%CI：0.98~1.01，P=0.502］。低NUF率对死亡风险的推定影响不是直接的（校正ADE=0.93，95%CI：0.81~1.05，P=0.274），而是通过其对体液平衡的影响介导（校正ACME=0.93，95%CI：0.87~0.98，P=0.018）。 结论： 与前48 h NUF率1.70~2.47 ml·kg-1·h-1相比，接受CRRT治疗的CSA-AKI患者NUF率>2.47和<1.70 ml·kg-1·h-1时90 d死亡风险升高。.

Publication types

  • English Abstract

MeSH terms

  • Acute Kidney Injury* / etiology
  • Acute Kidney Injury* / therapy
  • Aged
  • Cardiac Surgical Procedures*
  • Continuous Renal Replacement Therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Treatment Outcome
  • Ultrafiltration