Uchino Shigehiko
Department of Emergency and Critical Care Medicine, Saitama Medical Center, Saitama Medical School, Saitama, Japan.
Curr Opin Crit Care. 2006 Dec;12(6):538-43. doi: 10.1097/01.ccx.0000247448.94252.5a.
The aim of this article is to describe our current understanding of the epidemiology of acute renal failure, especially in severe cases requiring renal replacement therapy. Some data from an international observational study (the Beginning and Ending Supportive Therapy (BEST) for the kidney study) are also presented.
Multiple epidemiological studies for acute renal failure have been conducted in different populations using various criteria and reported a wide range of incidence and mortality. In several multicenter studies reporting the incidence of renal replacement therapy requirement in a general intensive care unit population, however, renal replacement therapy requirement and hospital mortality was quite similar among the studies, approximately 4% and 60%, respectively. In North and South America, nephrologists typically manage acute renal failure patients with intermittent renal replacement therapy. On the other hand, in Asia, Australia and Europe, intensivists are commonly responsible for managing these patients with continuous renal replacement therapy.
Although the epidemiology of acute renal failure is varied among regions and centers, the average incidence of renal replacement therapy requirement and hospital mortality in critical illness are similar in multicenter studies. Continuous renal replacement therapy is gaining popularity and intensivists are becoming responsible for managing patients with it. More studies are needed to understand acute renal failure epidemiology worldwide. To conduct such studies, consensus criteria for acute renal failure and a well performed acute renal failure-specific severity score will be required.
本文旨在描述我们目前对急性肾衰竭流行病学的认识，尤其是在需要肾脏替代治疗的严重病例中。还介绍了一项国际观察性研究（肾脏起始与终末期支持治疗（BEST）研究）的一些数据。
针对急性肾衰竭，已在不同人群中使用各种标准进行了多项流行病学研究，报告的发病率和死亡率范围很广。然而，在几项报告普通重症监护病房人群中肾脏替代治疗需求发生率的多中心研究中，各研究之间肾脏替代治疗需求和医院死亡率相当相似，分别约为4%和60%。在北美洲和南美洲，肾病学家通常采用间歇性肾脏替代治疗来管理急性肾衰竭患者。另一方面，在亚洲、澳大利亚和欧洲，重症医学专家通常负责采用连续性肾脏替代治疗来管理这些患者。
尽管急性肾衰竭的流行病学在不同地区和中心有所不同，但在多中心研究中，危重病中肾脏替代治疗需求的平均发生率和医院死亡率相似。连续性肾脏替代治疗越来越受欢迎，重症医学专家正负责管理接受该治疗的患者。需要更多研究来了解全球急性肾衰竭的流行病学。要开展此类研究，将需要急性肾衰竭的共识标准和完善的急性肾衰竭特异性严重程度评分。
