Objective To investigate the influence of the time of initiation of continuous renal replacement therapy (CRRT) on the survival and recovery of renal function in survivors of critically ill patients with acute kidney injury (AKI).Methods A retrospective analysis was performed on the data of critically ill patients with AKI,who were treated with CRRT from January 1,2009 to June 30,2011 in the Fourth Hospital of Hebei Medical University.According to Acute Kidney Injury Net (AKIN) classification at the beginning of CRRT,patients were stratified into AKIN 1,2,3 stages.The survival rate and kidney outcome in survivors were compared among these three AKIN groups.Additionally,the association among three influencing factors (duration of CRRT,CRRT dose and the filter life) and prognosis was analyzed.Results Fifty-two patients were enrolled,among them 15 were in AKIN 1 stage,23 in AKIN 2 stage,and 14 in AKIN 3 stage (among them the number of female patients was 14,16,6,respectively,P=0.014).① Survival analysis:the 28-,90-,and 180-day survival rate of AKIN 1,2 and 3 stages (28 days:53.3％,52.2％,61.5％; 90 days:46.7％,31.8％,46.2％; 180 days:35.7％,22.7％,46.2％),intensive care unit (ICU)survival rate (60.0％,65.2％,71.4％),and hospital survival rate (60.0％,60.9％,71.4％) showed no significant difference (all P＞0.05).COX proportional hazards model analysis showed that the 28-day survival rate was significantly correlated with the CRRT dose [relative risk (RR)=0.922,95％ confidence interval (95％CI) 0.856-0.994,P＜0.05].② Outcome of renal function in survivors:no significant difference in renal function recovery was found 28,90,180 days among AKIN 1,2 and 3 stages after CRRT (28 days:75.0％,66.7％,75.0％; 90 days:85.7％,71.4％,100.0％; 180 days:80.0％,60.0％,100.0％,all P＞0.05).Logistic regression analysis showed that it was correlated with none of the four influencing factors (gender,the filter life,duration of CRRT and CRRT dose).Conclusions Our results indicated that the time of initiation of CRRT by AKIN classification has no effect on the 28-,90-,180-day survival rate,ICU survival rate and outcome of renal function in survivors of critically ill patients with AKI.Improving CRRT dose may improve 28-day survival rate.%目的 探讨连续性肾脏替代治疗(CRRT)开始时机对合并急性肾损伤(AKI)重症患者存活率及生存患者肾功能恢复率的影响.方法 回顾性分析2009年1月1日至2011年6月30日河北医科大学第四医院重症医学科行CRRT治疗合并AKI重症患者的临床资料.根据急性肾损伤协作网(AKIN)不同分期作为开始CRRT治疗的时机将患者分为AKIN 1、2、3期组,比较3组存活率及生存者肾功能恢复率.进一步多元回归分析CRRT治疗天数、治疗剂量、滤器寿命等因素对预后的影响.结果 共入选52例患者,其中AKIN 1期15例,2期23例,3期14例；3组患者临床特征中仅性别比较差异有统计学意义(女性分别为14、16、6例,P=0.014).①生存分析:AKIN 1、2、3期患者CRRT治疗后28、90、180 d的存活率(28 d:53.3％、52.2％、61.5％,90 d:46.7％、31.8％、46.2％,180 d:35.7％、22.7％、46.2％)及重症监护病房(ICU)存活率(60.0％、65.2％、71.4％)和出院存活率(60.0％、60.9％、71.4％)比较差异均无统计学意义(均P＞0.05).进一步COX回归分析显示,CRRT治疗剂量是影响患者28 d病死率的独立保护因素[相对危险度(RR) =0.922,95％可信区间(95％ CI)为0.856～0.994,P＜0.05].②生存者肾功能恢复率分析:AKIN 1、2、3期患者CRRT治疗后28、90、180 d生存患者肾功能恢复率比较差异均无统计学意义(28 d:75.0％、66.7％、75.0％,90 d:85.7％、71.4％、100.0％,180 d:80.0％、60.0％、100.0％,均P＞0.05).进一步logistic回归分析显示,肾功能恢复率与上述影响因素均不存在线性相关性.结论 本研究提示,CRRT开始时机(以AKIN分期)对合并AKI重症患者28、90、180 d存活率及ICU、出院存活率以及生存者肾功能恢复率无影响；提高CRRT治疗剂量可能会改善患者28 d病死率.
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