Efficacy of oXiris filter in continuous renal replacement therapy on infection complicated with acute kidney injury after cardiac surgery
Objective To observe the efficacy of continuous renal replacement therapy(CRRT)with oXiris filter on infection complicated with acute kidney injury(AKI)after cardiac surgery,and to investigate its safety.Methods Seven patients with infection complicated with AKI after cardiac surgery were diagnosed and treated in the First Affiliated Hospital of Xinjiang Medical University from January to December 2023.All patients were given anti-infective treatment and CRRT with oXiris filter.The length of CRRT,comorbidities,length of ICU stay,length of hospital stay and survival were recorded.The data were compared before CRRT was started and terminated including left ventricular ejection fraction,haemoglobin,platelet count,N-terminal pro-brain natriuretic peptide,total bilirubin,blood creatinine,blood urea,urine output,interleukin-6,procalcitonin,prothrombin time,fibrinogen,activated partial thromboplastin time,mean arterial pressure,dopamine dosage,norepinephrine dosage,vasoactive drug score,blood lactate,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ)score,and Sequential Organ Failure Assessment(SOFA)score.Results(1)CRRT lasted for 45(14,118)h in 7 patients.Nasal bleeding occurred in 1 patient,small intestinal bleeding occurred in 1,and CRRT was terminated due to filter coagulation in 1.All 7 patients were transferred to the general ward after CRRT was terminated,among whom 2 died in hospital and 5 were discharged.The length of ICU stay was 17(10,34)d and the length of hospital stay was 38(16,54)d.(2)The left ventricular ejection fraction and total bilirubin were higher before CRRT was terminated[60.72％(60.09％,60.72％),(128.94±42.68)μmol/L]than those before CRRT was started[56.76％(55.12％,57.79％),(83.57±27.02)μmol/L](Z＞0.999,P=0.028;t=-2.463,P=0.049).The levels of N-terminal pro-brain natriuretic peptide,blood creatinine,blood urea and interleukin-6,as well as vasoactive drug score and SOFA score were lower before CRRT was terminated[(5 190.86±4 516.01)ng/L,79.00(77.45,97.91)μmol/L,(10.49±5.69)mmol/L,219.00(117.00,281.00)ng/L,14.71±6.71,8.86±3.60]than those before CRRT was started[(9 417.14±6 999.29)ng/L,176.82(146.44,229.79)μmol/L,(23.86±14.29)mmol/L,2 660.00(2 574.00,2 985.00)ng/L,30.14±11.46,11.43±3.54](t=2.500,Z＞0.999,t=2.833,Z＞0.999,t=3.446,t=4.204;all P values＜0.05).The norepinephrine dosage was lower before CRRT was terminated[(0.10±0.05)μg/(kg·min)]than that before CRRT was started[(0.24±0.11)μg/(kg·min)](t=3.571,P=0.012).The prothrombin time was shorter before CRRT was terminated[12.40(12.00,12.60)s]than that before CRRT was started[13.00(12.60,13.30)s](Z=2.000,P=0.047).There were no significant differences in the haemoglobin,platelet count,procalcitonin,activated partial thromboplastin time,fibrinogen,blood lactate,dopamine usage,mean arterial pressure,urine output and APACHEⅡ score before CRRT was terminated compared with those before CRRT was started(P＞0.05).Conclusion CRRT with oXiris filter benefits the volume management by effectively removing the inflammatory mediators from the blood,correcting haemodynamic parameters,and improving cardiac and renal function of patients with infection complicated with AKI after cardiac surgery.
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