중환자실에서 신대치요법이 급성신부전 중환자 예후에 미치는 영향

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.