ABSTRACT

Background: In critically ill children, sepsis-associated acute kidney injury (SA-AKI) has significant morbidity and mortality.

Aim: To estimate whether early initiation of peritoneal dialysis (PD) has a better short-term outcome than standard PD.

Methods: Early PD (n = 25) was defined as a need for PD in Kidney Disease: Improving Global Outcomes (KDIGO) stage 2 AKI, while those fulfilling the criteria for stage 3 KDIGO were categorised as a standard PD group (n = 25). The primary outcome measure was the estimated glomerular filtration rate (eGFR) at discharge or at 4 weeks after initiation of PD, whichever occurred earlier.

Results: A prospective cohort of 50 children (32 boys) aged 2 months to 16 years with SA-AKI who underwent PD were recruited. The most frequent indication for PD was fluid overload (40%), followed by persistent metabolic acidosis (36%). Children in the early PD group had lower creatinine and higher eGFR at discharge/4-week follow-up (p < 0.001). The duration of PD was less if it was commenced early (p < 0.04); 24 of 25 (96%) children in the early PD group were off PD within 6 days of initiation compared with 13 of 25 (52%) in the standard PD group (p < 0.001).

Conclusions: Compared with standard PD, early PD in SA-AKI resulted in a favourable renal outcome, decreased duration of PD and early discontinuation of dialysis.

Abbreviations : AKI: acute kidney injury; CRRT: continuous renal replacement therapy; CS-AKI: cardiac surgery-associated acute kidney injury; eGFR: estimated glomerular filtration rate; ELAIN: early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury; ESCAPE: effect of strict blood pressure control and ACE inhibition on the progression of chronic kidney disease in paediatric patients; HIC: high-income countries; ISN: international society of nephrology; KDIGO: Kidney Disease: Improving Global Outcomes; LMIC: low- to middle-income countries; PD: peritoneal dialysis; PICU: paediatric intensive care unit; RRT: renal replacement therapy; SA-AKI: sepsis-associated acute kidney injury; SYL: Saving Young Lives; SOFA: sequential (sepsis-related) organ failure assessment score; STARRT-AKI: standard versus accelerated initiation of renal replacement therapy in acute kidney injury.

摘要

背景：在重症儿童中，脓毒症相关的急性肾损伤 (SA-AKI) 具有显着的发病率和死亡率。

目的：评估早期开始腹膜透析 (PD) 是否比标准 PD 具有更好的短期结果。

方法: 早期 PD ( n = 25) 被定义为肾脏疾病需要 PD：改善全球结果 (KDIGO) 阶段 2 AKI，而满足 3 阶段 KDIGO 标准的那些被归类为标准 PD 组 ( n = 25 ）。主要结果测量是出院时或 PD 开始后 4 周时的估计肾小球滤过率 (eGFR)，以较早发生者为准。

结果：招募了 50 名接受 PD 的 2 个月至 16 岁的 SA-AKI 儿童（32 名男孩）的前瞻性队列。PD 最常见的适应症是液体超负荷（40%），其次是持续性代谢性酸中毒（36%）。早期 PD 组儿童出院/4 周随访时肌酐较低，eGFR 较高（p < 0.001）。早期开始 PD 持续时间较短（p < 0.04）；早期 PD 组 25 名儿童中有 24 名（96%）在开始 6 天内停止 PD，而标准 PD 组 25 名儿童中有 13 名（52%）（p < 0.001）。

结论：与标准 PD 相比，SA-AKI 的早期 PD 导致良好的肾脏结果，减少 PD 持续时间和提前终止透析。

缩写: AKI: 急性肾损伤；CRRT：持续性肾脏替代治疗；CS-AKI：心脏手术相关的急性肾损伤；eGFR：估计的肾小球滤过率；ELAIN：急性肾损伤危重患者早期与晚期开始肾脏替代治疗；ESCAPE：严格控制血压和抑制 ACE 对儿科患者慢性肾病进展的影响；HIC：高收入国家；ISN：国际肾脏病学会；KDIGO：肾脏疾病：改善全球成果；LMIC：中低收入国家；PD：腹膜透析；PICU：儿科重症监护室；RRT：肾脏替代疗法；SA-AKI：败血症相关的急性肾损伤；SYL：拯救年轻生命；SOFA：顺序（败血症相关）器官衰竭评估分数；开始-AKI：