Continuous Renal Replacement Therapy For Critical Ill Patients With Chronic Renal Failure: A Clinical Analysis

Objective:To observe the effect of continuous renal replacement therapy (CRRT)on critical ill patients with chronic renal failure(CRF).And to investigate the association between various factors and outcome.Methods:It was a retrospective study of the medical records of 62 patients who under CRRT treatment. All patients were CRF, and had been admitted into the Intensive Care Unit (ICU) of the First Affiliated Hospital of Zhejiang University between April 2008 and January 2010. For the purpose of the study, all patients were divided into survival group and non-survival group according to the 28-day survivorship. Then, compare the clinical index of patients pretherapy and 24 hours,48 hours,72 hours after treatment in both groups. And also compare some factors between groups before treatment and to do Multivariate analysis of the risk factor.Results:Causes of admitted to ICU, pulmonary infection in 28 (45.16%) patients and cerebrovascular accident in 10 (16.13%) patients, were the first two causes. On the basis of the 28-day survivorship, the over mortality was 38.71%. In the survival group, the serum creatinine (Scr). urea nitrogen (BUN),electrolyte disturbances,acid-intoxication,lactic acid (LD),APACHEII score,SAPSII score were improved significantly after therapy. Lencocyte count (WBC) and platelet count (PLT) were decreased significant after 24-hour treatment. But the haemodynamics (HR,MABP) and oxygenation index ((PO2/FiO2)) have no significance between pertherapy and post-therapy. In the non-survival group, the Scr, BUN, electrolyte disturbances and acid-intoxication can also be improved significantly. Haematochrome (Hb) reduced significantly after 72-hour therapy. Oxygenation index ((PO2/FiO2)), lencocyte count (WBC), lactic acid (LD),APACHEII score and haemodynamics had no significant change. The significant difference between the survival and non-survival groups were Age (P=0.005), Mechanical ventilation (P=0.005), Using of vasopressor (P=0.015), Cardiovascular disease CVD (P=0.037), Number of organ failure (P=0.037), Serum albumin level (p= 0.015), LD>2.0mmol/L(P=0.021), MABP (P=0.010), APACHEII score (P=0.001), SAPSII score (P=0.001).By logistic regression analysis, there were statistical significance for Age more than 70 year old (OR=7.194,95%CI: 0.030-0.631, P=0.011), Mechanical ventilation (OR=4.484,95%CI: 0.056-0.892, P=0.034),APACHEII more than 25 scores (OR=4.219,95%CI: 0.058-0.962, P=0.044), Alb<33g/L (OR=5.618,95%CI:0.040-0.795, P=0.024).Conclusion:Critical ill patients with CRF had high mortality, CRRT treatment can keep cleaning micromolecule toxinum, such as Scr and BUN, but has less impact to haemodynamics, also can correct the electrolyte disturbances and acid-intoxication. CRRT treatment can improve the prognosis of critical ill patients,but the severity of disease still influence the prognosis, so we should search more variables associated with prognosis and manage early.