Comparison Of The Therapeutic Effects Of CRRT In Critically Ill Patients With AKI Based On KDIGO Criteria

Objective:To evaluate the clinical indexes and prognosis of critically ill patients with Continuous Renal Replacement Therapy?CRRT?in different stages by using the Kidney Disease:Improving Global Outcomes Guidelines for Acute Renal Injury?AKI?diagnostic criteria,to explore the critical timing of CRRT therapy in critically ill patients with AKI under this standard.Methods:Retrospective analysis In patients with emergency ICU from the First Affiliated Hospital of Dalian Medical University from November 2014 to October 2016,patients who were diagnosed with AKI were treated with CRRT.According to the latest Scr value/urine volume before treatment,according to KDIGO-AKI diagnostic criteria divided into 1,2,3 stages and as a group.To compare the sex,age,primary diagnosis,hospitalization time,CRRT treatment time,the survival of the patients,whether or not the mechanical-assisted ventilation,the use of vasoactive drugs,the patient's acute physiology and chronic health status?APACHE??,sequential organ failure score?SOFA?,MAP,urine output,Scr,BUN,WBC,Hb,PLT,MPV,P-LCR,PCF,PDW,blood potassium,arterial blood pH?Lac and other biochemical indicators of the differences before and after CRRT treatment,using the logistic regression analysis of critically ill patients with AKI hospital mortality in the independent risk factors.Results:A total of 99 patients were included,including 33 patients in stage 1,24 in stage 2,42 in stage 3.Food/drug poisoning,sepsis,inflammation as the main cause,group 1 patients with more food/drug poisoning as the incentive,group 2,group 3 to sepsis-based.There were no significant differences in WBC,serum potassium,arterial blood pH and blood Lac between the three groups before treatment?P>0.05?.During the course of treatment,the treatment time and mechanical ventilation rate of CRRT were significantly different between the three groups?P<0.05?.The treatment time was the shortest in group 2,the treatment time was the longest(P_1:2=0.009<0.05?P_1:3=0.023<0.05).There was no significant difference between the three groups?P=0.073>0.05?.There were significant differences in urine output,Scr,P-LCR,PDW and Hb between the three groups after treatment?P<0.05?.The mean time of hospitalization was different in the three groups.The time of treatment was the same as that of CRRT,the group 2 was the shortest,the group 3 had the longest(P_2:3=0.012<0.05).The recovery rate of renal function in the three groups decreased with the AKI staging?P=0.022<0.05?,There was a difference between group 1and group 3(P_1:3=0.007<0.05).A total of 37 patients died and the total hospital mortality rate was 37.4%.There was a significant difference in mortality among the three groups?18.2%vs 54.2%vs 38.1%,P=0.016<0.05?.Group 1 patients with lower mortality,Compared with group 3,the recovery rate of renal function and the time of CRRT were significantly different in group 1 patients.Multivariate logistic regression analysis showed that the time of CRRT treatment??=-8.31?OR=3.84?p=0.05?95%CI0.996¹.054?,the use of mechanical ventilation before treatment??=1.836,OR=6.27,p=0,95%CI:2.729¹4.404?and the PLT after treatment??=0.018,OR=1.019,p=0.003,95%CI:1.006¹.031?was the independent risk factor for the prognosis of patients with AKI.Conclusions:1.food/drug poisoning,sepsis,inflammation?severe pneumonia,pancreatitis,etc.?,subarachnoid hemorrhage,cerebral hemorrhage and others are the causes of critically ill AKI,of which food/drug poisoning,sepsis is the main.2.For critically ill patients with AKI,patients who started CRRT had a higher rate of renal function recovery and a lower mortality rate.3.Compared with APACHE?score,SOFA score showed a better predictive ability for the prognosis of critically ill patients with AKI.The smaller the SOFA score was,the lighter the renal damage was.4.CRRT treatment time,the application of mechanical ventilation before treatment,platelet count after treatment,is the prognosis of patients with AKI is an independent risk factor.This retrospective study based on the KDIGO-AKI criteria showed that early initiation of CRRT treatment contributed to the recovery of renal function,but no significant improvement in hospital mortality.In view of the complexity of this intervention and the diversity of results,there was a need for a large number of Prospective clinical trials to further study the best time to treat with CRRT.