LI Mingpeng 1,2 , ZHANG Ling 2 , LIU Li 1 , TANG Xin 2 , ZHANG Yong 1 , YANG Yingying 2 , FU Ping 2 , CHEN Dezheng 1
  • 1. Department of Nephrology, Jianyang People’s Hospital, Jianyang, Sichuan 641400, P. R. China;
  • 2. Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
CHEN Dezheng, Email: 670054896@qq.com
Bee sting; acute kidney injury; continuous renal replacement therapy; intermittent hemodialysis
10.7507/1002-0179.202206006
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Objective  To evaluate the efficacy and safety of intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) on patients with acute kidney injury (AKI) after bee sting. Methods  A prospective observational analysis was made on patients with AKI after bee sting treated in Jianyang People’s Hospital or West China Hospital of Sichuan University between July 2015 and December 2020. According to different initial renal replacement therapy modes, the patients were divided into IHD group and CRRT group. The IHD group received hemodialysis for 4 hours each time, once a day or 3-5 times a week; the CRRT group used Prismaflex machine for continuous veno-venous hemofiltration or continuous veno-venous hemodiafiltration within 72 hours after admission, for at least 12 hours a day, followed by CRRT or IHD, depending on the patient’s condition. Both groups could be treated with hemoperfusion (HP) and symptomatic support such as glucocorticoid, blood transfusion and fluid rehydration. The IHD group was divided into IHD subgroup and IHD+HP subgroup, and the CRRT group was divided into CRRT subgroup and CRRT+HP subgroup according to whether renal replacement therapy was combined with HP. The basic information of patients and clinical laboratory examination results were collected, and the renal function recovery and mortality rates of patients in the two groups were compared, as well as the changes of laboratory indicators. Results  A total of 106 patients were enrolled, 50 in the IHD group and 56 in the CRRT group. There was no statistical difference in the rate of complete renal function recovery 30, 60, or 90 days after treatment between the two groups (28.2% vs. 31.2%, P=0.758; 46.2% vs. 50.0%, P=0.721; 82.1% vs. 81.2%, P=0.924). But in the CRRT subgroup analysis, there was a statistical difference in the 30-day renal function recovery rate of CRRT+HP patients compared with CRRT alone (47.6% vs. 18.5%, P=0.031), while no statistical difference was found in the IHD subgroup analysis. After 3 days of treatment, the levels of creatine kinase of the IHD+HP subgroup and the CRRT+HP subgroup were lower than those in the IHD and CRRT subgroups, and the differences were statistically significant [(7875±6871) vs. (15157±8546) U/L, P=0.026; (10002±8256) vs. (14498±10362) U/L, P=0.032]. There was no statistical difference in 30-day mortality or incidence of serious adverse reactions between the two groups (P>0.05). Conclusions  There is no obvious difference in improving renal prognosis or reducing mortality between CRRT and IHD for patients with AKI after bee sting. However, CRRT combined with HP therapy could shorten the recovery time of renal function and increase the 30-day kidney recovery rate. HP may contribute to early renal function recovery in patients with AKI after bee sting, but more high-quality randomized controlled trials are needed to further confirm this.

Citation： LI Mingpeng, ZHANG Ling, LIU Li, TANG Xin, ZHANG Yong, YANG Yingying, FU Ping, CHEN Dezheng. Renal prognosis of patients with acute kidney injury after bee sting with different renal replacement therapy modes. West China Medical Journal, 2022, 37(7): 1009-1015. doi: 10.7507/1002-0179.202206006 Copy

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