Kellum John A, Mehta Ravindra L, Angus Derek C, Palevsky Paul, Ronco Claudio
Department of Critical Care Medicine and Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Kidney Int. 2002 Nov;62(5):1855-63. doi: 10.1046/j.1523-1755.2002.00613.x.
Management of acute renal failure (ARF) in the critically ill is extremely variable and there are no published standards for the provision of renal replacement therapy in this population. We sought to review the available evidence, make evidence-based practice recommendations, and delineate key questions for future study.
We undertook an evidence-based review of the literature on continuous renal replacement therapy (CRRT) using MEDLINE searches. We determined a list of key questions and convened a 2-day consensus conference to develop summary statements via a series of alternating breakout and plenary sessions. In these sessions, we identified supporting evidence and generated practice guidelines and/or directions for future research.
Of the 46 questions considered, we found consensus for 20. We found inadequate evidence for 21 questions and for the remaining five we found data but no consensus. Full versions of workgroup findings are available on the Internet at http://www.ADQI.net.
Despite limited data, broad areas of consensus exist for use of CRRT and guideline development appears feasible. Equally broad areas of disagreement also exist and additional basic and applied research in acute renal failure is needed.
危重症患者急性肾衰竭（ARF）的管理差异极大，且目前尚无针对该人群提供肾脏替代治疗的公开标准。我们旨在回顾现有证据，提出基于证据的实践建议，并明确未来研究的关键问题。
我们通过MEDLINE检索对连续性肾脏替代治疗（CRRT）的文献进行了循证综述。我们确定了一系列关键问题，并召开了为期2天的共识会议，通过一系列交替进行的分组讨论和全体会议来制定总结声明。在这些会议中，我们确定了支持证据，并生成了实践指南和/或未来研究方向。
在审议的46个问题中，我们对其中20个达成了共识。对于21个问题，我们发现证据不足；对于其余5个问题，我们找到了相关数据，但未达成共识。工作组研究结果的完整版本可在互联网上查阅，网址为http://www.ADQI.net。
尽管数据有限，但在CRRT的使用方面存在广泛的共识领域，指南制定似乎是可行的。同样也存在广泛的分歧领域，因此需要对急性肾衰竭进行更多的基础研究和应用研究。
