Urgent-Start Peritoneal Dialysis in Metformin-Associated Lactic Acidosis: A Critical Alternative when Immediate Hemodialysis Is Unavailable.

IF 2.2 3区医学 Q3 HEMATOLOGY Blood Purification Pub Date : 2024-10-14 DOI:10.1159/000542003

Watanyu Parapiboon, Jakkrid Banjong, Chirakhana Siangtrong, Theerapun Boonsayomphu, Wirayut Silakun

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Abstract

Introduction: Intermittent hemodialysis (IHD) is a preferable renal replacement therapy (RRT) option in metformin-associated lactic acidosis (MALA) due to rapid correct metabolic acidosis. However, IHD might not be started immediately. Immediate urgent-start peritoneal dialysis (iUSPD) is used as a life-saving dialysis option and then followed by IHD. The outcomes of iUSPD were compared with other extracorporeal dialysis in MALA.

Methods: In two tertiary hospitals in Thailand, the outcomes of patients with MALA who had received three different RRT modalities (iUSPD followed by IHD, IHD, and continuous renal replacement therapy [CRRT]) from January 2015 to December 2019 were compared. The primary outcome was 30-day mortality. The secondary outcomes were door-to-dialysis time and 90-day RRT dependence.

Results: A total of 180 MALA cases that required dialysis were included (20 iUSPD, 120 IHD, and 40 CRRT). Their mean age was 64 years. Most of the patients had severe metabolic acidosis (mean pH 6.91, HCO3 6 mmol/L, and anion gap 40 mmol/L) and were critically ill. The 30-day mortality was 30% in iUSPD, 9.2% in IHD, and 32.5% in CRRT (p = 0.001). The mortality risk in the iUSPD group was not significantly different from those of the IHD and CRRT groups (adjusted HR 2.5, 95% CI: 0.65-9.6, and adjusted HR 0.75, 95% CI: 0.2-2.78, respectively). All dialysis modalities had comparable 90-day dialysis dependence. iUSPD exhibited the shortest door-to-dialysis time.

Conclusion: In MALA, iUSPD followed by IHD might be a viable RRT option to save patient lives if no other dialysis options are available.

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二甲双胍相关性乳酸酸中毒患者紧急启动腹膜透析：当无法立即进行血液透析时的关键替代方案。

导言间歇性血液透析（IHD）是二甲双胍相关性乳酸酸中毒（MALA）的首选肾脏替代疗法（RRT），因为它能迅速纠正代谢性酸中毒。然而，IHD 可能无法立即启动。立即紧急启动腹膜透析（iUSPD）是一种挽救生命的透析方法，然后再进行 IHD。我们对 iUSPD 与其他体外透析在 MALA 中的效果进行了比较。方法在泰国的两家三级医院，比较了 2015 年 1 月至 2019 年 12 月期间接受三种不同 RRT 模式（iUSPD 后 IHD、IHD 和持续肾脏替代疗法 [CRRT]）的 MALA 患者的治疗效果。主要结果是 30 天死亡率。次要结果是门到透析时间和 90 天 RRT 依赖性。结果纳入了 180 例需要透析的 MALA 病例（20 例 iUSPD、120 例 IHD 和 40 例 CRRT）。他们的平均年龄为 64 岁。大多数患者患有严重的代谢性酸中毒（平均 pH 值为 6.91，HCO3 为 6 mmol/L，阴离子间隙为 40 mmol/L），病情危重。iUSPD 患者的 30 天死亡率为 30%，IHD 患者为 9.2%，CRRT 患者为 32.5%（P = 0.001）。iUSPD 组的死亡风险与 IHD 组和 CRRT 组无明显差异（调整后 HR 分别为 2.5，95% CI 0.65-9.6 和 0.75，95% CI 0.2-2.78）。所有透析方式的 90 天透析依赖性相当，iUSPD 的门到透析时间最短。结论在 MALA 中，如果没有其他透析方案，iUSPD 后 IHD 可能是挽救患者生命的可行 RRT 方案。

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来源期刊

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.