심혈관계 수술 후 급성신부전의 초기 신대체요법으로 지속적 정정맥 혈액투석여과법의 의의 = Clinical Significance of Continuous Veno-Venous Hemodiafiltration as an Initial Renal Replacement Therapy for Acute Renal Failure after Cardiovascular Surgery

다국어 초록 (Multilingual Abstract)

Background:Although continuous venovenous hemodiafiltration (CVVHDF) has many therapeutic advantages, previous studies did not report the improvement of survival rate by CVVHDF compared to that by hemodialysis (HD). It could be attributed to that they did not analyze the results under the appropriate stratification of severity and to multiorgan failure.
Methods:We performed retrospective study to compare the outcomes of 88 patients with acute renal failure after major cardiovascular surgery(s). Among them, 48 patients (M:F=32:16, Age 58±11 years) were treated by CVVHDF and 40 patients (M:F=27:13, Age 59±10 years) were treated by HD. The severity of illness was estimated by APACHE III score system at the initiation of renal replacement therapy (RRT) and we also evaluated renal outcome and survival.
Results:There was no significant difference between two groups in baseline characteristics, cause of surgery, survival rate and renal outcome. However, compared with those of HD group, CVVHDF group showed longer period of application with mechanical ventilator (p=0.001), longer period of vasopressor use (p<0.001), longer stay in intensive care unit (p=0.004) and higher APACHE III score at the initiation of renal replacement therapy (p=0.009). Among those with APACHE III scores over 90, survivors existed in CVVHDF group with the survival rate of 50%. In contrast, there was no one who survived in HD group (p=NS).
Conclusion:Although this study revealed that CVVHDF could be more useful than HD as an initial RRT for the patients with renal failure after major cardiovascular surgery, the randomized prospective study will be required to accept clinical usefulness of CVVHDF.

국문 초록 (Abstract)

배 경 : 지속적 정정맥 혈액투석여과법은 많은 장점을 가지고 있음에도 불구하고 고식적 혈액투석과 비교시 생존율의 우위를 보여주지 못하였다. 이는 원인 질환의 중증도의 보정이 이루어지지 않았음과 다장기부전에 기인할 가능성이 있다. 방 법 : 이에 저자들은 심혈관계 수술 후 급성신부전을 보인 88명의 환자 중, 지속적 정정맥 혈액투석여과법을 시행 받은 48명 (남 : 여=32 : 16, 나이 58±11세)과 고식적 혈액투석을 시행 받은 40명 (남 : 여=27 : 13, 나이 59±10세)을 대상으로 후향적 연구를 통해 치료 성적을 비교하고자 하였다. 질환의 중증도는 신대체요법 시작 당시 APACHE III 점수를 이용하였으며 신기능의 변화와 생존 여부를 평가하였다.결 과 : 두 군간에 일반적 특성, 수술 이유, 생존율, 신기능의 변화 정도에 차이는 없었다. 하지만 지속적 정정맥 혈액투석여과법을 시행 받은 환자군이 혈액투석을 받은 군에 비해 인공 호흡기의 사용기간 (p=0.001), 승압제의 사용기간 (p<0.001), 중환자실 재원 기간 (p=0.004)이 길었으며 신대체요법 시작 당시의 APACHE III 점수도 높아 (p=0.009) 중환이었음을 알 수 있었다. APACHE III 점수가 91점 이상인 경우, 지속적 정정맥 혈액투석여과법을 받은 군은 50 %의 생존율을 보인 반면, 고식적 혈액투석을 받은 군에서는 생존자가 없었다. 하지만 통계적 유의성을 보이지는 못했다.

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