Continuous Renal Replacement Therapy For Geriatric Critical Ill Patients With Acute Kidney Injury:a Clinical Analysis

Objective:To observe the effect of continuous renal replacement therapy(CRRT) on geriatric critical ill patients with acute kidney injury(AKI). And to investigate the association between various factors and outcome.Methods:It was a retrospective study of the medical records of119geriatric patients with AKI who under CRRT treatment. All patients had been admitted into the Intensive Care Unit(ICU) of the First Affiliated Hospital of Zhejiang University between January2008and November2009. For the purpose of the study, all patients were divided into survival group and non-survival group according to the28-day survivorship. Then, compare the clinical index of patients pretherapy and24hours,48hours after treatment in both groups. And also compare some factors between groups before treatment and to do multivariate logistic regression analysis of the risk factors.Results:Causes of AKI, pulmonary infection in45(37.82%) patients, cardiovascular disease in17(14.39%) patients and late malignant tumor in13(10.92%) patients,were the first three causes. The haemodynamics have no significance between pertherapy and post-therapy. On the basis of the28-day survivorship, the over mortality was57.14%, and5(9.80%) patients need maintenance hemodialysis treatments.In both group, the serum creatinine(Scr), blood urea nitrogen(BUN) and acid-intoxication were improved significantly after therapy. In the survival group, lactic acid(LD) were decreased significant after24-hour treatment, APACHE Ⅱ score were improved significantly after24-hour and48-hour therapy while in the non-survival group had no significant change. The significant differences between the survival and non-survival groups were Using of vasopressor,Mechanical ventilation, Number of organ failure, APACHE Ⅱ score, SAPS Ⅱ score, Serum direct bilirubin level(TB),Platelet count(PLT), LD, Oxygenation index(PO2/FiO2) and (mean arterial pressure)MAP.By logistic regression analysis,there were statistical significance for LD more than3mmol/L (OR=5.457,95%CI:1.735～15.326, P=0.003), APACHE Ⅱ score more than23(OR=3.049,95%CI:1.224～7.592, P=0.017), Using of vasopressor (OR=3.337,95%CI:1.325～8.405, P=0.011), PLT less than70×109/L(OR=4.288,95%CI:1.356～13.559,P=0.013), MAP less than80mmHg (OR=3.172,95%CI:1.262～7.972, P=0.014). Conclusions:Geriatric critical ill patients with AKI had high mortality and poor prognosis.Including LD, APACHE Ⅱ score, Using of vasopressor, PLT, MAP before treatment were independent prognostic predictors. LD and APACHE Ⅱ score improved significantly after early therapy predict outcome in patients with good.