The Timing Of Renal Replacement Therapy In Patients With Sepsis-associated AKI

Objective:To explore the effects of different time to start RRT on the prognosis of patients with SI-AKI,provide a reference for the rational selection of RRT timing,reduce the mortality and disability rate of SI-AKI patients,improve the treatment effect,and reduce the economic burden of patients.METHODS: Patients from the Department of Critical Care Medicine,First People's Hospital of Guiyang,March 2017 to September 2018,who met the 2016 SSC published diagnostic criteria for sepsis 3.0,and who met the AKI-2 diagnostic criteria established by KDIGO in 2012,were randomized.Divided into early combined late group.The early group underwent RRT within 6 hours after randomization;the late group developed life-threatening complications after randomization(including BUN ? 30 mmol/L;K+ ? 6.0 mmol/L or K+ ? 5.5 mmol/L after active medical treatment;It is difficult to correct metabolic acidosis,PH?7.15;acute pulmonary edema caused by fluid overload,diuretic is ineffective;oliguria or anuria persists ?72 hours)RRT is performed.The same blood purification machine,dialysis membrane and extracorporeal circulation tube were used in both groups,and the RRT unified adopts the CVVH mode.Finally,the 28-day and 60-day mortality rates and the incidence of related adverse events and complications were compared between the two groups.Collect complete data using SPSS 22.0 statistical software for statistics and analysis.The normal distribution measurement data is expressed as mean ± standard deviation,the non-normal distribution measurement data is represented by median(interquartile range),the count material is expressed by frequency or rate,and the normal distribution measurement data is t test,non The normal distribution measurement data is non-parametric test,and the count data is 2 test.P< 0.05 was considered statistically significant.RESULTS: A total of 31 patients were included,including 15 in the early group and 16 in the advanced group.In the end,10 people died within 28 days,including 4 in the early group(26.7%)and 6 in the late group.A total of 12 people died within 60 days,including 6 in the early group(40%)and 6 in the late group(37.5).%).The 28-day and 60-day mortality rates of the two groups were compared using the 2 test.The results were P>0.05,and the difference was not statistically significant.In the final late group,9(56.2%)avoided renal replacement therapy.The early group did not need to receive ventilator treatment for 10 days(0-15)days,and the late group did not need to receive ventilator treatment for 10(0-12.75)days.There was no significant difference between the two groups(Z =-0.403,P=0.687).The early group did not need to use the booster drug for 21(0-25)days in 28 days,and the late group did not need to use the booster drug for 15(0-18.75)days.The difference between the two groups was statistically significant(Z=-2.156,P=0.031).The 28-day non-ICU hospitalization days in the early group were 9(0-12)days,and the non-ICU hospitalization days in the late group were 4.5(0-6.5)days.There was a statistically significant difference in non-ICU hospitalization between the two groups(Z=-2.379,P=0.017).The SOFA scores of the early group were 10.33±2.29 and 7.93±2.28,respectively,and the patients in the late group were 10.00±1.90 and 7.88±2.39 respectively.The early APACHEII scores on the 3rd and 7th days were 18.87±2.45.16.87±2.45,the late group was 19.44±2.53/16.50±2.94.After comparison,there was no significant difference in SOFA and APACHE II scores between the two groups on the 3rd and 7th day after treatment.In the early group,catheter-related bloodstream infection occurred in 2 patients(13.3%)and in the advanced group(6.3%).There was no significant difference between the two groups(Z=0.444,P=0.505).There were 6 cases of hypophosphatemia in the early group and only 1 case in the late stage.The incidence of hypophosphatemia in the early group was significantly higher than that in the late group,and the difference was statistically significant(Z=5.044,P=0.025).CONCLUSIONS: In patients with SI-AKI who do not have life-threatening complications in the ICU,early initiation of RRT may not improve survival,nor reduce RRT dependence,and increase the chances of renal function recovery.