Early goal-directed renal replacement therapy in severe pneumonia associated acute kidney injury

Severe pneumonia is a crucial issue in the development of acute kidney injury (AKI). This study evaluated the efficacy of early goal-directed renal replacement therapy (GDRRT) for the treatment of severe pneumonia-associated AKI. In this real-world retrospective cohort study, we recruited 180 patients with severe pneumonia who were hospitalized and received GDRRT in a third-class general hospital in East China between January 1, 2017, and December 31, 2021. Clinical data on baseline characteristics, biochemical indicators, and renal replacement therapy were collected. Patients were divided into Early and Late RRT groups according to fluid status, inflammation progression, and pulmonary radiology. We investigated in-hospital all-cause mortality (primary endpoint) and renal recovery (secondary endpoint) between the two groups. Among the 154 recruited patients, 80 and 74 were in the early and late RRT groups, respectively. There were no significant differences in the demographic characteristics between the two groups. The duration of admission to RRT initiation was significantly shorter in Early RRT group [2.5(1.0, 8.7) d vs. 5.0(1.5,13.5) d, <i>p</i> = 0.027]. At RRT initiation, the patients in the Early RRT group displayed a lower percentage of fluid overload, lower doses of vasoactive agents, higher CRP levels, and higher rates of radiographic progression than those in the Late RRT group. The all-cause in-hospital mortality was significantly lower in the Early RRT group than in Late group (52.5% vs. 86.5%, <i>p</i> &lt; 0.001). Patients in the Early RRT group displayed a significantly higher proportion of complete renal recovery at discharge (40.0% vs. 8.1%, <i>p</i> &lt; 0.001). This study clarified that early GDRRT for the treatment of severe pneumonia-associated AKI based on fluid status and inflammation progression, was associated with reduced hospital mortality and better recovery of renal function. Our preliminary study suggests that early initiation of RRT may be an effective approach for severe pneumonia-associated AKI.

重症肺炎是急性肾损伤（AKI）发生发展的关键临床问题。本研究评估了早期目标导向肾脏替代治疗（GDRRT）用于治疗重症肺炎相关性AKI的临床疗效。本项真实世界回顾性队列研究纳入了2017年1月1日至2021年12月31日期间，华东地区某三级综合医院收治的180例住院重症肺炎且接受GDRRT的患者，收集了患者的基线特征、生化指标及肾脏替代治疗相关临床资料。研究人员根据患者液体状态、炎症进展情况及肺部影像学结果，将其分为早期RRT组与晚期RRT组，以两组患者的住院全因死亡率（主要终点）与肾脏恢复情况（次要终点）为观察指标。最终纳入分析的154例患者中，早期RRT组与晚期RRT组分别有80例和74例。两组患者的人口统计学特征无显著差异。早期RRT组患者从住院至启动RRT的时长显著短于晚期RRT组[2.5(1.0, 8.7)天 vs. 5.0(1.5,13.5)天，p=0.027]。在启动RRT时，早期RRT组患者的液体超负荷占比、血管活性药物使用剂量均低于晚期RRT组，而C反应蛋白（CRP）水平及影像学进展率则更高。早期RRT组的住院全因死亡率显著低于晚期RRT组（52.5% vs. 86.5%，p<0.001）。出院时，早期RRT组患者的肾功能完全恢复占比显著高于晚期RRT组（40.0% vs. 8.1%，p<0.001）。本研究证实，基于液体状态与炎症进展情况启动早期GDRRT治疗重症肺炎相关性AKI，可降低住院死亡率并改善肾功能恢复情况。本初步研究提示，早期启动RRT或为重症肺炎相关性AKI的有效治疗方案。