Clinical Study On The Optimization Mode Of Blood Purification Therapy In Patients With Acute Kidney Injury

Part 1 Effect of the intensity of continuous renal replacement therapy on patients with cardiac surgery-associated acute kidney injuryIntroduction.Cardiac surgery-associated acute kidney injury(CSA-AKI)is a major complication in patients with cardiac surgery and is an independent predictor of mortality.However,the optimal intensity of renal replacement therapy for such patients is still controversial.Methods.From March 20,2012 to August 9,2015,we randomly assigned 211 patients with CSA-AKI to continuous renal replacement therapy(CRRT)with different treatment doses(35 ml/kg/h or 25 ml/kg/h).The primary study outcome was death from any cause within 14,28,90 and 365 days.The secondary outcome was the renal outcome of survivors at 14,28,90 and 365 days after randomization.The results were analyzed by univariate and multivariate methods and by Kaplan-Meier survival curves.Results.A total of 112 patients were given 35 ml/kg/h and 99 patients were given 25 ml/kg/h.High-intensity group and low-intensity group 14-day survival rates were 71/112(63.39%)and 65/99(65.66%),P=0.576;the 28-day survival rate were 61/112(54.46%)and 55/99(55.56%),P=0.690;the 90-day survival rate were 51/112(45.54%)and 47(47.47%),P=0.674;the 365-day survival rate were 46/112(41.07%)and 42/99(42.42%),P=0.108.There were also no differences between the groups in the renal outcomes of survivors at 14,28,90 or 365 days.Conclusions.In patients with cardiac surgery-associated acute kidney injury,the intensity of renal replacement therapy of approximately 25 and 35 ml/kg/h had no effect on survival at 14,28,90 or 365 days.This study showed that 25 ml/kg/h was is enough for cardiac surgery-associated acute kidney injuryPart 2 Development of multi-effect absorber and its clinical application in sepsis with acute kidney injuryBackground: Septic shock,a leading cause of acute kidney injury,induces release of pro-/anti-inflammatory mediators,leading to increased mortality and poor renal recovery.Blood adsorption technology is general y recognized as a means to remove macromolecular toxins,but the current adsorber can remove only a limited amount of sepsis toxins.Once the infection develops to sepsis,it has triggered the inflammatory cascade effect.Clearing endotoxin alone can't prevent the progress of the disease;but clearing only inflammatory factors,but not the source of inflammatory factors-endotoxin,is also difficult to improve the prognosis.Objective: To develop a new type of sepsis multi effect blood adsorber,in order to remove endotoxin and inflammatory mediators at the same time,so as to improve the prognosis of sepsis at the source of inflammatory waterfall.Methods: Cytosorb is the most studied inflammatory factor specific adsorber,and Cytosorb is composed of PS-DVB microparticles.Polymyxin B(PMB)can combine with lipid A,an important structure of endotoxin,and destroy the cell wall of bacteria.It can be used to treat gram-negative bacilli infection at present.The purpose of this study is to construct an improved adsorber of polystyrene-diethylene polymer combined with polymyxin B,and to observe the effect of the improved adsorber on the removal of inflammatory factors and endotoxin.Results: The adsorption rate of P-PMB was 94.3% in endotoxin adsorption in 2 hours.The hemolysis rate was 2.9%,and there was no obvious cytotoxic effect.Conclusion: The combination of PS-DVB and PMB can significantly improve the adsorption capacity of endotoxin,has good blood compatibility and no obvious cytotoxic effect.it provided a new strategy for the treatment of sepsis.