Bouchard Josée, Weidemann Charlotte, Mehta Ravindra L
Department of Medicine, Division of Nephrology, University of California San Diego, San Diego, CA, USA.
Adv Chronic Kidney Dis. 2008 Jul;15(3):235-47. doi: 10.1053/j.ackd.2008.04.004.
Approximately 4% of all critically ill patients will require renal replacement therapy (RRT). Despite its potential reversibility, acute kidney injury has a significant impact on morbidity and mortality. Numerous studies have addressed the questions of modality choice and dose of RRT in the intensive care unit setting. There is no clear evidence that one renal replacement modality is superior to another. Two multicenter trials focusing on dialysis dose will probably be published in the next year, either confirming or invalidating the benefit of higher effluent rates. Another key aspect in the treatment of acute kidney injury is the consequence of RRT on long-term renal function. Although cohort studies have shown that continuous RRT shortens dialysis-dependence compared with intermittent hemodialysis, randomized trials and meta-analyses do not support these findings. Several unanswered questions, such as the timing of initiation and cessation of RRT, the modification of dialysis parameters over the course of acute kidney injury and the influence of fluid status need to be addressed in future trials in order to improve outcomes related to this condition.
所有重症患者中约4%需要肾脏替代治疗（RRT）。尽管急性肾损伤具有潜在可逆性，但它对发病率和死亡率有重大影响。众多研究探讨了重症监护病房环境下RRT的模式选择和剂量问题。没有明确证据表明一种肾脏替代模式优于另一种。两项关注透析剂量的多中心试验可能会在明年发表，要么证实更高超滤率的益处，要么否定其益处。急性肾损伤治疗中的另一个关键方面是RRT对长期肾功能的影响。尽管队列研究表明，与间歇性血液透析相比，持续RRT可缩短透析依赖时间，但随机试验和荟萃分析并不支持这些发现。为了改善与这种疾病相关的预后，未来的试验需要解决几个未解决的问题，如RRT开始和停止的时机、急性肾损伤过程中透析参数的调整以及液体状态的影响。
