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NEJM:肾脏替代治疗不能降低急性肾损伤危重患者的死亡风险

2020-07-16 MedSci原创 MedSci原创

对于急性肾损伤的危重病人中,提高肾脏替代使用率并不能降低患者90天内死亡风险。

急性肾损伤在危重病人中很常见,其中许多人接受肾脏替代治疗,但肾脏替代治疗开始的最有效时机仍不确定。
 
近日研究人员进行了一项多国、随机、对照试验,招募严重急性肾损伤的危重患者,随机接受快速肾脏替代治疗(患者达到符合标准后的12小时内开始治疗)或标准策略(除非出现常规适应症或急性肾损伤持续时间>72小时,否则不鼓励肾替代治疗)。研究的主要结果是90天死亡率。
 
3019名患者参与研究,其中2927名(97.0%)纳入改良意向治疗分析(快速组1465名,标准组1462名)。快速组1418例(96.8%)和标准策略组903例(61.8%)患者接受了肾脏替代治疗。90天时,快速组643例(43.9%)患者死亡,标准组639例(43.7%),相对危险为1.00。在90天的幸存者中,快速组814名患者中有85名(10.4%)证实需持续依赖肾脏替代治疗,而标准策略组815名患者中有49名(6.0%)需持续依赖肾脏替代治疗(相对风险,1.74)。快速组1503例患者中有346例发生不良事件(23.0%),标准策略组1489例患者中有245例(16.5%)。
 
研究认为,对于急性肾损伤的危重病人中,提高肾脏替代使用率并不能降低患者90天内死亡风险。
 
原始出处:
 
The STARRT-AKI Investigators for the Canadian Critical Care Trials Group, the Australian and New Zealand Intensive Care Society Clinical Trials Group, the United Kingdom Critical Care Research Group, the Canadian Nephrology Trials Network, and the Irish Critical Care Trials Group. Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury. N Engl J Med, July 16, 2020.

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    2020-07-16 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

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