중환자실에서 신대치요법이 급성신부전 중환자 예후에미치는 영향 = Renal Replacement Therapies on the Outcomes of Acute Renal Failure Patients in ICU

다국어 초록 (Multilingual Abstract)

Background: The worldwide standard of renal replacement therapy for acute renal failure patients is intermittent hemodialysis (IHD). Continuous renal replacement therapy (CRRT) has recently emerged as an alternative modality. We performed the study to find the effects of renal replacement therapy on outcome of the acute renal failure patients in the ICU.
Methods: 373 adult patients under the diagnosis of acute renal failure (ARF) in the ICUs (medical-surgical and coronary care unit) at Severance Hospital Yonsei University College of Medicine between January 1, 1998 and July 31, 2002 were included. Patients with ARF were divided into two groups depending on their need for renal replacement therapy. Renal replacement therapy group was subdivided into IHD and CRRT group.
Results: There was significant difference in the mortality between renal replacement group and non-renal replacement group, 74.4% vs. 45.2% (P ＜ 0.001). Renal function recovery rate of renal replacement group was lower compared to that of non-renal replacement group, 36 % vs. 59% (P ＜ 0.001). APACHE II score, ventilator support, vasopressors, number of organ failure, and oliguria during RRT were higher in CRRT group than in IHD group (P ＜ 0.001). CRRT group was associated with higher mortality rate, CRRT 86.2% vs. IHD 42.2% and lower renal function recovery rate, CRRT 9.8% vs. IHD 63.0% (P ＜ 0.001).
Conclusions: Although the result of this study implies that IHD is associated with better survival and better renal recovery, the preferred use of CRRT in severely ill patients with an unstable circulatory system must be reminded. (Korean J Anesthesiol 2004; 46: 593～598)

참고문헌 (Reference)

1 "To dialyze or not to dialyze: An ethical and evidence-based approach to the patient with acute renal failure in the intensive care unit" 4 : 288-296, 1997

2 "Prognostic stratification in critically ill patients with acute renal failure requiring dialysis" 155 : 1505-1511, 1995

3 "Prognosis of acute tubular necrosis: An extended prospectively contrasted study" 63 : 21-31, 1993

4 "Outcome prediction of acute renal failure in medical intensive care" 17 : 19-24, 1991

5 "Long- term outcomes in acute renal failure patients treated with continuous renal replacement therapies" 40 : 275-279, 2002

6 "Influence of renal replacement therapy on outcome of patients with acute renal failure" S72 : 75-78, 1999

7 "Hospital-acquired renal insufficiency: a prospective study" 74 : 243-248, 1983

8 "Dialysing the patient with acute renal failure in the ICU; the emperor's clothes" 14 : 2570-2573, 1999

9 "Daily hemodialysis and the outcome of acute renal failure" 345 : 305-310, 2002

10 "Continuous versus intermittent renal replacement therapy: a meta-analysis" 28 : 29-37, 2002

11 "Continuous versus intermittent dialysis for acute renal failure (ARF) in the ICU: results from a randomized multicenter tri" 7 : 1457-, 1996

12 "Comparing continuous hemofiltration with hemodialysis in patients with severe acute renal failure" 34 : 424-132, 1999

13 "Cause of death in acute renal failure" 7 : 230-234, 1992

14 "Acute renal failure: definition and pathogenesis" 53(Suppl.66) : S7-10, 1998

15 "Acute renal failure treated by haemofiltration: factors affecting outcome" 86 : 81-90, 1993

16 "Acute renal failure in the medical intensive care unit: predisposing, complicating factors and outcome" 59 : 602-610, 1991

17 "Acute renal failure in intensive care units-causes, outcome and prognostic factors of hospital mortality; a prospective, multicenter study. French Study Group on Acute Renal Failure" 24 : 192-198, 1996

18 "Acute renal failure in intensive care units-Causes, outcome, and prognostic factors of hospital mortality" 24 : 192-198, 1996

19 "Acute renal failure after coronary intervention: incidence, risk factors and relationship to mortality" 103 : 368-375, 1997

20 "Acute dialytic support for the critically ill: intermittent hemodialysis versus continuous arteriovenous hemodiafiltration" 15 : 192-200, 1995

21 "A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure" 60 : 1154-1163, 2001

22 "A prospective, multicenter study of the epidemiology, management, and outcome of severe acute renal failure in a "closed" ICU system" 162 : 191-196, 2000

23 "A comparison of conventional dialytic therapy and acute continuous hemodiafiltration in the management of acute renal failure in the critically ill" 15 : 595-602, 1993

24 "50 years: The crush syndrome" 301 : 1412-1415, 1990