Kritik hastalarda diyaliz gerektiren akut böbrek yetmezliğinin klinik özellikleri ve kısa dönemli sonuçları

Öz

Amaç: Diyaliz gerektiren akut böbrek hasarı yoğun bakım ünitelerinde yüksek mortalite ve diyalize bağımlı kronik böbrek hastalığı gibi olumsuz sonuçları ile ilişkilidir. Bu retrospektif çalışma günümüz yoğun bakım pratiğinde diyaliz gerektiren akut böbrek hasarının klinik özelliklerini ve renal replasman tedavi yöntemlerini tanımlamayı amaçlamıştır.
Yöntemler: Bu retrospektif kohort çalışma, bir üniversite hastanesinin 20 yataklı üçüncü basamak yoğun bakım ünitesinde 2011-2017 arasında gerçekleştirilmiştir. Toplamda, renal replasman tedavisi uygulanan 145 diyaliz gerektiren akut böbrek hasarı hastası tanımlanmıştır. Diyaliz gerektiren akut böbrek hasarı hastalarının hastane kayıtları demografi, tıbbi öykü, klinik özellikler, renal replasman tedavisi detayları ve ısa dönemli sonuçlar için retrospektif olarak analiz edilmiştir.
Bulgular: İncelenen 1689 hastanın 145’inde diyaliz gerektiren akut böbrek hasarı mevcuttu. Dahil edilen hastaların ortanca yaşı 73 idi. septik etiyoloji, diyaliz gerektiren akut böbrek hasarı gelişiminde en sık şüphelenilen nedendi. Elli iki hasta (%35,9) sürekli renal replasman tedavisi hastaya uygulanmışken 93 hastaya (%64,1) aralıklı hemodiyaliz uygulanmıştır. Sürekli renal replasman tedavisi uygulanan hastalarda mekanik ventilasyon ve inotrop desteği daha sık kullanılmıştır (P=0,03). Toplamda, hastane içi mortalite oranı %73,1 iken taburculukta diyaliz bağımlı kronik böbrek hastalığı oranı %6,2 idi. mortalite oranı sürekli renal replasman tedavisi uygulanan hastalarda anlamlı olarak daha yüksekti (%84,6’ya karşılık %66,7, P=0,019).
Sonuç: Çalışmamızın bulguları yoğun bakım hastalarında diyaliz gerektiren akut böbrek hasarının en önemli nedeninin sepsis olduğunu göstermektedir. Diyaliz gerektiren akut böbrek hasarı yaşlı hastalarda daha fazla görülmüştür ve kısa dönemli mortalite riskinde artış ile ilişkilidir. 

Anahtar Kelimeler

• Kritik hasta
• Akut böbrek hasarı
• Diyaliz
• Sürekli renal replasman tedavisi
• Aralıklı hemodiyaliz

Clinical characteristics and short-term outcome of dialysis-requiring acute kidney injury in critically ill patients

Abstract

Aim: Dialysis-requiring acute kidney injury (D-AKI) in intensive care unit (ICU) continues to be associated with adverse outcomes of high mortality and dialysis-dependent chronic kidney disease (CKD). This retrospective study aimed to identify clinical characteristics of dialysis-requiring AKI and renal replacement therapy (RRT) which replaces the normal blood-filtering function of the kidneys in current ICU practice.
Methods: This retrospective cohort study was conducted in a 20-bed, third level ICU of a University Hospital between 2011 and 2017. In total, 145 D-AKI patients who underwent RRT were identified. Hospital records of patients with D-AKI were retrospectively analyzed for demographics, medical history, clinical characteristics, details of RRT modality, and short-term outcome.
Results: Of the 1689 patients investigated, 145 had D-AKI. The median age of the patients included in the study was 73 years. Septic etiology was the most common suspected cause for D-AKI development. Fifty-two patients (35.9%) underwent continuous RRT (CRRT) while intermittent hemodialysis was used in 93 patients (64.1%). Mechanical ventilation and inotropic support were more commonly used in CRRT patients than IHD patients (P=0.03). In total, in-hospital mortality rate was 73.1% while rate of dialysis-dependent CKD on discharge was 6.2%. Mortality rate was significantly higher in CRRT (84.6%) patients than in IHD patients (66.7%, P=0.019).
Conclusion: Our study results reveal that sepsis appears to be the most important cause of D-AKI in intensive care patients. D-AKI was observed more frequently in elderly patients and associated with an increased risk of short-term mortality.

Keywords

• Critically ill patients
• Acute kidney injury
• Dialysis
• Continuous renal replacement therapy
• Intermittent hemodialysis

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