Overberger Pamela, Pesacreta Matthew, Palevsky Paul M
Research Service, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240-0001, USA.
Clin J Am Soc Nephrol. 2007 Jul;2(4):623-30. doi: 10.2215/CJN.00780207. Epub 2007 May 9.
Data on current practices for management of renal replacement therapy (RRT) in acute kidney injury (AKI) are limited, particularly with regard to the dosing of therapy.
DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: A survey was conducted of practitioners at the 27 study sites that participate in the Veterans Affairs/National Institutes of Health Acute Renal Trial Network (ATN) Study before initiation of patient enrollment for ascertainment of the local prevailing practices for management of RRT in critically ill patients with AKI. Surveys were returned from 130 practitioners at 26 of 27 study sites; the remaining study site provided aggregate data.
Intermittent hemodialysis and continuous RRT were the most commonly used modalities of RRT, with sustained low-efficiency dialysis and other "hybrid" treatments used in fewer than 10% of patients. Intermittent hemodialysis was most commonly provided on a thrice-weekly or every-other-day schedule, with only infrequent assessment of the delivered dosage of therapy. Most practitioners reported that they did not dose continuous RRT on the basis of patient weight. The average prescribed dosage of therapy corresponded to a weight-based dosage of no more than 20 to 25 ml/kg per h.
These results provide insight into clinical management of RRT and provide normative data for evaluation of the design of ongoing clinical trials.
关于急性肾损伤（AKI）中肾脏替代治疗（RRT）当前管理实践的数据有限，尤其是在治疗剂量方面。
设计、地点、参与者和测量方法：在27个参与退伍军人事务部/国立卫生研究院急性肾试验网络（ATN）研究的研究地点，在患者入组前对从业者进行了一项调查，以确定当地对重症AKI患者RRT管理的普遍做法。27个研究地点中的26个收到了130名从业者的调查问卷回复；其余研究地点提供了汇总数据。
间歇性血液透析和连续性RRT是最常用的RRT模式，持续低效透析和其他“混合”治疗在不到10%的患者中使用。间歇性血液透析最常见的是每周三次或隔天进行，很少对所给予的治疗剂量进行评估。大多数从业者报告称，他们不会根据患者体重来确定连续性RRT的剂量。平均规定治疗剂量相当于基于体重的剂量不超过每小时20至25 ml/kg。
这些结果为RRT的临床管理提供了见解，并为评估正在进行的临床试验设计提供了规范数据。
