Renal Replacement in Acute Kidney Injury During Moderate Metabolic Disarray

中度代谢紊乱期间急性肾损伤的肾脏替代治疗

• 批准号: 8320534
• 负责人: FRANCIS PERRY WILSON
• 金额: $ 7.23万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-05 至 2013-07-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8320534
• 关键词: Acidosis; Acute Renal Failure with Renal Papillary Necrosis; Affect; Animal Model; Azotemia; Basic Science; Biochemical; Blood - brain barrier anatomy; Blood Urea Nitrogen; Cessation of life; Clinical; Clinical Research; Complication; Critical Illness; Data; Data Analyses; Development; Dialysis procedure; Disease; Distant; Dose; Early treatment; Electrolytes; Excision; Exclusion; Future; Hemodialysis; Hospital Mortality; Hospitals; Inflammatory Response; Injury; K-Series Research Career Programs; Kidney; Laboratories; Learning; Leukocyte Trafficking; Life; Manuscripts; Master of Science; Measurable; Measures; Mediating; Metabolic; Methods; Metric; Minor; Modeling; Observational Study; Oliguria; Outcome; Patients; Process; Publications; Recovery; Renal Replacement Therapy; Research; Research Design; Research Methodology; Research Priority; Research Project Grants; Risk; Serum; Severities; Syndrome; Time; Toxin; Up-Regulation; Variant; Work; base; clinical epidemiology; clinical practice; cohort; design; epidemiology study; experience; hyperkalemia; improved; mortality; prophylactic; response; solute; Acidosis; Acute Renal Failure with Renal Papillary Necrosis; Affect; Animal Model; Azotemia; Basic Science; Biochemical; Blood - brain barrier anatomy; Blood Urea Nitrogen; Cessation of life; Clinical; Clinical Research; Complication; Critical Illness; Data; Data Analyses; Development; Dialysis procedure; Disease; Distant; Dose; Early treatment; Electrolytes; Excision; Exclusion; Future; Hemodialysis; Hospital Mortality; Hospitals; Inflammatory Response; Injury; K-Series Research Career Programs; Kidney; Laboratories; Learning; Leukocyte Trafficking; Life; Manuscripts; Master of Science; Measurable; Measures; Mediating; Metabolic; Methods; Metric; Minor; Modeling; Observational Study; Oliguria; Outcome; Patients; Process; Publications; Recovery; Renal Replacement Therapy; Research; Research Design; Research Methodology; Research Priority; Research Project Grants; Risk; Serum; Severities; Syndrome; Time; Toxin; Up-Regulation; Variant; Work; base; clinical epidemiology; clinical practice; cohort; design; epidemiology study; experience; hyperkalemia; improved; mortality; prophylactic; response; solute

DESCRIPTION (provided by applicant): Acute kidney injury (AKI) is a common complication of critical illness, with even minor degrees of AKI conferring an independent risk of death (1, 2). No therapy currently exists that has been definitively demonstrated to improve outcomes in AKI, although renal replacement therapy (RRT) is frequently necessary as a life-sustaining measure once oliguria, severe azotemia, or significant electrolyte abnormalities develop. Defining the indications for and timing of RRT in the setting of AKI is a priority research topic identified by the Acute Kidney Injury Network. Prior studies examining timing of RRT in acute kidney injury typically have been limited to patients with AKI who received RRT, rendering them unable to evaluate the indications for this therapy, and the impact of therapy versus no therapy (3, 4). Reframing the questions regarding RRT in the setting of AKI, we have designed a study to examine the impact on mortality of initiating dialysis therapy during a period of moderate metabolic disarray, defined as the period of time after acute kidney injury, when laboratory abnormalities are detectable, but before absolute indications for dialysis have arisen. We take advantage of the variations in clinical practice during early AKI prior to when RRT is required as a life-sustaining measure to design an observational study that will permit us to accomplish the following specific aims: Aim 1: Develop a metric defining moderate metabolic disarray and assess the association of duration and severity of moderate metabolic disarray prior to initiation of RRT with the rate of mortality. We will create a score based on a multiple regression model of likelihood to receive dialysis based on a variety of factors, and use that likelihood to define degree of disarray. We will then assess the impact of duration and severity of moderate disarray with these methods (censored at initiation of dialysis or development of severe disarray) on predicting in-hospital mortality. Aim 2: Assess the impact of renal replacement therapy (RRT) initiated during moderate metabolic disarray on in-hospital mortality in a cohort of critically ill patients with AKI The proposed research project will be in the context of the applicant working towards a Masters of Science in Clinical Epidemiology, whereby didactic learning in the classroom, focusing on fundamentals of epidemiology, study design, and statistical and analytic methods of research will enhance and guide the research process of the applicant. The long-term objectives of the applicant for this project are to collect and analyze the data, prepare manuscripts for publication, and build upon the data as part of a future application for a K award.

描述（由申请人提供）：急性肾脏损伤（AKI）是危重疾病的常见并发症，即使是AKI的较小程度也赋予了独立的死亡风险（1，2）。尽管肾脏替代疗法（RRT）经常是必需的，但目前尚无尚未有明确证明可以改善AKI预后的治疗方法，因为一旦寡尿症，严重的偶氮血症或明显的电解质异常发展，肾脏替代疗法（RRT）通常是维持生命的措施。在AKI设置中定义RRT的指示和时间是由急性肾脏损伤网络确定的优先研究主题。先前检查急性肾脏损伤中RRT时间的研究通常仅限于接受RRT的AKI患者，使他们无法评估这种疗法的适应症，以及治疗与无治疗的影响（3，4）。在AKI的环境中，我们设计了一项研究，以研究在中等代谢混乱的时期开始对透析治疗的死亡率的影响，该影响定义为急性肾脏损伤后的时间，当时实验室异常可检测到透明度的绝对指示，以确保透析的绝对指示。我们利用在需要RRT作为一种维持生命的措施之前，在AKI中的临床实践中的变化来设计一项观察性研究，该研究将使我们能够实现以下具体目标：目标1：建立一个定义中度代谢混乱的度量标准，并在与中等代谢混乱的持续时间和中等代谢混乱的持久性差异率相关性，该指标与中等的代谢混乱相关性。我们将基于多个可能性回归模型来创建一个分数，以基于多种因素接收透析，并使用这种可能性定义混乱程度的可能性。然后，我们将通过这些方法（启动透析或严重混乱的发展或发展严重混乱的发展）评估中度混乱的持续时间和严重程度对预测院内死亡率的影响。 Aim 2: Assess the impact of renal replacement therapy (RRT) initiated during moderate metabolic disarray on in-hospital mortality in a cohort of critically ill patients with AKI The proposed research project will be in the context of the applicant working towards a Masters of Science in Clinical Epidemiology, whereby didactic learning in the classroom, focusing on fundamentals of epidemiology, study design, and statistical and analytic methods of研究将增强和指导申请人的研究过程。申请人对该项目的长期目标是收集和分析数据，准备出版的手稿，并以数据为基础，作为将来的K奖励申请的一部分。