Reduction Rate of Uric Acid in Blood During Continuous Renal Replacement Therapy for Acute Kidney Injury: A Multicenter Retrospective Observational Study.

IF 2.2 3区医学 Q3 HEMATOLOGY Blood Purification Pub Date : 2024-10-29 DOI:10.1159/000542329

Yutaro Inoue, Ryota Inokuchi, Hidehiko Nakano, Yoshiki Masuda, Osamu Nishida, Kent Doi

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Abstract

Introduction: Continuous renal replacement therapy (CRRT) eliminates these small solutes with equal efficacy under the same conditions. However, variations in the reduction rates of these solutes observed in patients with CRRT are likely influenced by factors other than removal through CRRT. This study evaluated the reduction rates of these small solutes during CRRT and their possible association with mortality.

Methods: This study used the data of limited patients registered in the CHANGE study, which is a large retrospective observational study on CRRT management across 18 Japanese ICUs. Reduction rates of three solutes in blood, calculated on the 1st and 2nd days, were compared in patients with acute kidney injury (AKI) treated by CRRT. The potential association between solute reduction rates and mortality during CRRT or within 7 days after the termination of CRRT was evaluated.

Results: In total, 163 patients with AKI were included in the analysis. The reductuin rates of uric acid (UA) were significantly higher than those of urea and creatinine for the 1st and 2nd tests in the entire cohort. Receiver operating curve (ROC) analysis revealed that lower UA reduction rates were significantly associated with mortality during CRRT or within 7 days after CRRT termination (area under the ROC curve: 0.62 [95% confidence interval {CI} 0.52-0.71] for the 1st test and 0.63 [95%CI 0.54-0.72] for the 2nd test). After adjusting for age and SOFA score, a significant association was observed between lower UA reduction rates and hospital mortality for both tests.

Conclusion: Among the small solutes, UA reduction rates in patients with AKI treated with CRRT were notably higher than those of creatinine and urea. Furthermore, the significant association between lower UA reduction rates and mortality suggests that UA reduction rate may serve as a valuable indicator of insufficient removal of uremic solutes by CRRT, although the decline in UA production must be taken into account.

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急性肾损伤持续肾替代治疗期间血液中尿酸的降低率：一项多中心回顾性观察研究。

导言：在相同条件下，持续性肾脏替代疗法（CRRT）清除这些小溶质的效果相同。然而，在接受 CRRT 治疗的患者身上观察到的这些溶质减少率的变化很可能受到 CRRT 清除效果以外的其他因素的影响。本研究评估了 CRRT 期间这些小溶质的减少率及其与死亡率的可能关联：该研究是一项关于日本 18 家重症监护病房 CRRT 管理的大型回顾性观察研究。研究比较了接受 CRRT 治疗的急性肾损伤（AKI）患者第 1 天和第 2 天血液中三种溶质的减少率。评估了溶质减少率与 CRRT 期间或 CRRT 终止后 7 天内死亡率之间的潜在联系：共有 163 名 AKI 患者参与了分析。在整个队列中，尿酸（UA）的还原率明显高于尿素和肌酐的还原率。接收操作曲线（ROC）分析表明，尿酸还原率较低与 CRRT 期间或 CRRT 终止后 7 天内的死亡率显著相关（ROC 曲线下面积：0.62 [95% 置信区间(95%)]）：第一次测试为 0.62 [95% 置信区间 {CI} 0.52-0.71]，第二次测试为 0.63 [95%CI 0.54-0.72]）。在对年龄和SOFA评分进行调整后，观察到两种测试中较低的UA降低率与住院死亡率之间存在显著关联：结论：在小溶质中，接受 CRRT 治疗的 AKI 患者的尿酸降低率明显高于肌酐和尿素。结论：在小溶质中，接受 CRRT 治疗的 AKI 患者的尿酸减少率明显高于肌酐和尿素的减少率。此外，尿酸减少率降低与死亡率之间的显著关联表明，尿酸减少率可作为 CRRT 清除尿毒症溶质不足的一个重要指标，但必须考虑到尿酸生成量的下降。

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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.