Email Alerts
RSS
Volume 40 Issue 5
May  2024
Turn off MathJax
Article Contents
Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2024  >  40(5): 468-475
Heng X,Li CM,Liu W,et al.Analysis of effects and influencing factors of continuous renal replacement therapy in severe burn patients complicated with acute kidney injury[J].Chin J Burns Wounds,2024,40(5):468-475.DOI: 10.3760/cma.j.cn501225-20240207-00052.
Citation: Heng X,Li CM,Liu W,et al.Analysis of effects and influencing factors of continuous renal replacement therapy in severe burn patients complicated with acute kidney injury[J].Chin J Burns Wounds,2024,40(5):468-475.DOI: 10.3760/cma.j.cn501225-20240207-00052.
shu

Analysis of effects and influencing factors of continuous renal replacement therapy in severe burn patients complicated with acute kidney injury

doi: 10.3760/cma.j.cn501225-20240207-00052

  • Institute of Burn Research, State Key Laboratory of Trauma and Chemical Poisoning, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing 400038, China

Funds:

Youth Science Fund Program of National Natural Science Foundation of China 82002036

Military Medical Science and Technology Youth Training Plan 20QNPY011

More Information
    Abstract
  •   Objective  To preliminarily evaluate the effects and analyze the influencing factors of continuous renal replacement therapy (CRRT) in severe burn patients complicated with acute kidney injury (AKI).  Methods  This study was a retrospective case series study. From January 2010 to December 2020, 79 severe burn patients complicated with AKI who received CRRT and met the inclusion criteria were admitted to the First Affiliated Hospital of Army Medical University (the Third Military Medical University). The general data (the same below) of all patients were collected, including gender, age, body mass index, burn area, burn index, cause of injury, whether combined with inhalation injury, acute physiology and chronic health status evaluation Ⅱ (APACHE Ⅱ) score and sepsis-related organ failure assessment (SOFA) score on admission, admission time after burn, and time of AKI after admission. The total efficacy of CRRT, including overall effective rate, complete effective rate, partial effective rate, ineffective rate, and deterioration rate, creatinine, urea, cystatin C, and fluid overload rate before and after treatment, in-hospital mortality, predictive mortality based on Baux scoring model, the most common cause of death, and length of hospital stay were recorded. According to the effect of CRRT, the patients were divided into effective group (42 patients) and ineffective group (37 patients). The general information of patients, the time to initiate CRRT after the occurrence of AKI, the duration of CRRT, etiology of AKI, AKI stage before CRRT initiation, CRRT mode, anticoagulant type, and in-hospital mortality were compared between the two groups of patients. The independent influencing factors for CRRT in severe burn patients complicated with AKI were screened. According to the etiology of AKI, the patients were divided into prerenal group (22 patients) and renal group (57 patients). The general information of patients, the time to initiate CRRT after the occurrence of AKI, the duration of CRRT, and total efficacy of CRRT (except for the most common cause of death) were compared between the two groups of patients.  Results  Among the 79 patients, 73 cases were male and 6 cases were female, with age of (46±14) years, body mass index of (24.0±2.9) kg/m2, total burn area of (69±26)% total body surface area (TBSA), full-thickness burn area of (44±25)%TBSA, and burn index of 57 (36, 76). There were 36 cases of flame burns, 19 cases of electrical burns, 16 cases of hydrothermal burns, 6 cases of explosive burns, and 2 cases of chemical burns. Thirty-nine patients were complicated with inhalation injury. The APACHE Ⅱ score was 16 (12, 18) and the SOFA score was 11 (5, 13) on admission. The patients were admitted to the hospital on 0 (0, 2) d after burn, and AKI occurred on 0 (0, 6) d after admission. The overall effective rate of CRRT was 53.16% (42/79), the complete effective rate was 30.38% (24/79), the partial effective rate was 22.78% (18/79), the ineffective rate was 31.65% (25/79), and the deterioration rate was 15.19% (12/79). The creatinine and urea of patients after treatment were significantly lower than those before treatment (with Z values of -3.26 and -2.54, respectively, P<0.05); there were no statistically significant differences in the cystatin C and fluid overload rate of patients before and after treatment (P>0.05). The in-hospital mortality of patients was 17.72% (14/79), and the predictive mortality based on Baux scoring model was 75.10% (18.94%, 91.84%). The most common cause of death was multiple organ failure, and the length of hospital stay was 39.43 (11.52, 110.58) d. There were statistically significant differences in the full-thickness burn area, the duration of CRRT, and etiology of AKI of patients between effective group and ineffective group (with Z values of -1.99 and -2.90, respectively, χ2=5.58, P<0.05). There were no statistically significant differences in the other indicators (P>0.05). The etiology of AKI and full-thickness burn area were the independent influencing factors for CRRT in severe burn patients complicated with AKI (with odds ratios of 4.21 and 1.03, respectively, 95% confidence intervals of 1.20-14.80 and 1.00-1.05, respectively, P<0.05). There were statistically significant differences in the cause of injury, overall effective rate of CRRT, total burn area, burn index, admission time after burn, time of AKI after admission, the time to initiate CRRT after the occurrence of AKI, and predictive mortality based on Baux score model of patients between prerenal group and renal group (with χ2 values of 12.59 and 5.58, respectively, Z values of 2.46, 2.43, -2.43, -4.03, -3.01, and -2.31, respectively, P<0.05). Before treatment, urea and cystatin C of patients in renal group were significantly higher than those in prerenal group (with Z values of -2.98 and -2.77, respectively, P<0.05), and the liquid overload rate was significantly lower than that in prerenal group (Z=-2.99, P<0.05); after treatment, the cystatin C of patients in renal group was significantly higher than that in prerenal group (Z=-2.08, P<0.05); there were no statistically significant differences in the other indicators (P>0.05).  Conclusions  CRRT can significantly improve renal function, avoid fluid overload, and alleviate renal injury in severe burn patients complicated with AKI. Prerenal AKI is the main independent influencing factor leading to ineffective CRRT.

     

    • FullText(HTML)
  • loading
    • References(30)
  • [1]
    MartinsJ,NinN,MurielA,et al.Early acute kidney injury is associated with in-hospital adverse outcomes in critically ill burn patients: an observational study[J].Nephrol Dial Transplant,2023,38(9):2002-2008.DOI: 10.1093/ndt/gfac339.
    [2]
    DuanZY, CaiGY, LiJJ, et al. Meta-analysis of renal replacement therapy for burn patients: incidence rate, mortality, and renal outcome[J]. Front Med(Lausanne), 2021, 8: 708533. DOI: 10.3389/fmed.2021.708533.
    [3]
    FolkestadT,BrurbergKG,NordhuusKM,et al.Acute kidney injury in burn patients admitted to the intensive care unit: a systematic review and meta-analysis[J].Crit Care,2020,24(1):2.DOI: 10.1186/s13054-019-2710-4.
    [4]
    AlvarezG,ChruschC,HulmeT,et al.Renal replacement therapy: a practical update[J].Can J Anaesth,2019,66(5):593-604.DOI: 10.1007/s12630-019-01306-x.
    [5]
    中国医院协会血液净化中心分会和中关村肾病血液净化创新联盟“血液净化模式选择工作组”.血液净化模式选择专家共识[J].中国血液净化,2019,18(7):442-472.DOI: 10.3969/j.issn.1671-4091.2019.07.002.
    [6]
    ConnorMJJr, KarakalaN. Continuous renal replacement therapy: reviewing current best practice to provide high-quality extracorporeal therapy to critically ill patients[J]. Adv Chronic Kidney Dis, 2017, 24(4): 213-218. DOI: 10.1053/j.ackd.2017.05.003.
    [7]
    RoncoC, RicciZ, De BackerD, et al.Renal replacement therapy in acute kidney injury: controversy and consensus[J].Crit Care,2015,19(1):146.DOI: 10.1186/s13054-015-0850-8.
    [8]
    SwansonJW, OttoAM, GibranNS, et al. Trajectories to death in patients with burn injury[J]. J Trauma Acute Care Surg, 2013, 74(1): 282-288. DOI: 10.1097/TA.0b013e3182788a1c.
    [9]
    TanChor Lip H, TanJH, ThomasM, et al. Survival analysis and mortality predictors of hospitalized severe burn victims in a Malaysian burns intensive care unit[J/OL]. Burns Trauma, 2019, 7: 3[2024-02-07]. https://pubmed.ncbi.nlm.nih.gov/30705904/. DOI: 10.1186/s41038-018-0140-1.
    [10]
    MasonSA, NathensAB, ByrneJP, et al. Increased rate of long-term mortality among burn survivors: a population-based matched cohort study[J]. Ann Surg, 2019, 269(6): 1192-1199. DOI: 10.1097/SLA.0000000000002722.
    [11]
    KhwajaA.KDIGO clinical practice guidelines for acute kidney injury[J].Nephron Clin Pract,2012,120(4):c179-184.DOI: 10.1159/000339789.
    [12]
    GohCY,VisvanathanR,LeongCT,et al.A prospective study of incidence and outcome of acute kidney injury among hospitalised patients in Malaysia (My-AKI)[J].Med J Malaysia,2023,78(6):733-742.
    [13]
    ChawlaLS,BellomoR,BihoracA,et al.Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup[J].Nat Rev Nephrol,2017,13(4):241-257.DOI: 10.1038/nrneph.2017.2.
    [14]
    LinJ, JiXJ, WangAY, et al. Timing of continuous renal replacement therapy in severe acute kidney injury patients with fluid overload: a retrospective cohort study[J]. J Crit Care, 2021, 64: 226-236. DOI: 10.1016/j.jcrc.2021.04.017.
    [15]
    ChiuYJ, HuangYC, ChenTW, et al. A systematic review and meta-analysis of extracorporeal membrane oxygenation in patients with burns[J]. Plast Reconstr Surg, 2022, 149(6): 1181e-1190e. DOI: 10.1097/PRS.0000000000009149.
    [16]
    国家慢性肾病临床医学研究中心,中国医师协会肾脏内科医师分会,中国急性肾损伤临床实践指南专家组.中国急性肾损伤临床实践指南[J]. 中华医学杂志, 2023, 103(42): 3332-3366. DOI: 10.3760/cma.j.cn112137-20230802-00133.
    [17]
    ZarbockA, NadimMK, PickkersP, et al. Sepsis-associated acute kidney injury: consensus report of the 28th Acute Disease Quality Initiative workgroup[J]. Nat Rev Nephrol, 2023, 19(6): 401-417. DOI: 10.1038/s41581-023-00683-3.
    [18]
    ClarkA,NeyraJA,MadniT,et al.Acute kidney injury after burn[J].Burns,2017,43(5):898-908.DOI: 10.1016/j.burns.2017.01.023.
    [19]
    ZuccariS, DamianiE, DomiziR, et al. Changes in cytokines, haemodynamics and microcirculation in patients with sepsis/septic shock undergoing continuous renal replacement therapy and blood purification with cytosorb[J]. Blood Purif, 2020, 49(1/2): 107-113. DOI: 10.1159/000502540.
    [20]
    ZengXX,ZhangL,WuTX,et al.Continuous renal replacement therapy (CRRT) for rhabdomyolysis[J].Cochrane Database Syst Rev,2014,2014(6):CD008566.DOI: 10.1002/14651858.CD008566.pub2.
    [21]
    DuchnowskiP, ŚmigielskiW.Usefulness of the N-terminal of the prohormone brain natriuretic peptide in predicting acute kidney injury requiring renal replacement therapy in patients undergoing heart valve surgery[J]. Medicina (Kaunas),2023,59(12):2083.DOI: 10.3390/medicina59122083.
    [22]
    TandukarS, PalevskyPM. Continuous renal replacement therapy: who, when, why, and how[J]. Chest, 2019, 155(3): 626-638. DOI: 10.1016/j.chest.2018.09.004.
    [23]
    TsujimotoY, FujiiT. How to prolong filter life during continuous renal replacement therapy?[J]. Crit Care, 2022, 26(1): 62. DOI: 10.1186/s13054-022-03910-8.
    [24]
    KarkarA,RoncoC.Prescription of CRRT: a pathway to optimize therapy[J].Ann Intensive Care,2020,10(1):32.DOI: 10.1186/s13613-020-0648-y.
    [25]
    LiL, LiX, XiaYZ, et al. Recommendation of antimicrobial dosing optimization during continuous renal replacement therapy[J]. Front Pharmacol, 2020, 11: 786. DOI: 10.3389/fphar.2020.00786.
    [26]
    LegrandM, TolwaniA. Anticoagulation strategies in continuous renal replacement therapy[J]. Semin Dial, 2021 ,34(6):416-422.DOI: 10.1111/sdi.12959.
    [27]
    刘峰,黄正根,彭毅志,等.严重烧伤早期行连续性血液净化治疗的可行性及疗效随机对照临床试验[J].中华烧伤杂志,2016,32(3):133-139.DOI: 10.3760/cma.j.issn.1009-2587.2016.03.002.
    [28]
    YouB,ZhangYL,LuoGX,et al.Early application of continuous high-volume haemofiltration can reduce sepsis and improve the prognosis of patients with severe burns[J].Crit Care,2018,22(1):173.DOI: 10.1186/s13054-018-2095-9.
    [29]
    GaudryS, HajageD, BenichouN, et al. Delayed versus early initiation of renal replacement therapy for severe acute kidney injury: a systematic review and individual patient data meta-analysis of randomised clinical trials[J]. Lancet, 2020, 395(10235): 1506-1515. DOI: 10.1016/S0140-6736(20)30531-6.
    [30]
    HillDM, RizzoJA, AdenJK, et al. Continuous venovenous hemofiltration is associated with improved survival in burn patients with shock: a subset analysis of a multicenter observational study[J]. Blood Purif, 2021, 50(4/5): 473-480. DOI: 10.1159/000512101.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(1)  / Tables(4)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (127) PDF downloads(24) Cited by()
    Proportional views
    Related

    Copyright © Chinese Journal of Burns京ICP备07035254号-14

    E-mail：shaoshangzazhi@163.com

    Website：https://zhsszz.xml-journal.net/

    Supported by: Beijing Renhe Information Technology Co. Ltd    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return