Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA.
Am J Kidney Dis. 2010 Mar;55(3):570-9. doi: 10.1053/j.ajkd.2009.11.007. Epub 2010 Feb 8.
Prescribing dialysis to manage acute kidney injury (AKI) is common and recently has become a controversial area for physicians. The concept of dialysis "dose" initially was developed for end-stage renal disease and has been extended to AKI in the last decade. Urea kinetic modeling has been the mainstay of dose quantification in end-stage renal disease. Extrapolation of these techniques to critically ill patients with AKI is difficult because of a non-steady state leading to a variable increase in urea generation rate, alterations in total-body water and its compartmental distribution, and changing renal excretory capacity. Additional challenges are imposed when dose is considered for different modalities of dialysis that vary in operational characteristics (diffusion, convection, and adsorption), duration (intermittent and continuous), and frequency. The purpose of this article is to review the concept of dialysis dose, perform a critical assessment of the most important clinical trials of dialysis dose in AKI, summarize clinical evidence from these trials, and define key research issues that should be addressed in the future.
为急性肾损伤（AKI）制定透析方案很常见，最近已成为医生关注的热点问题。透析“剂量”的概念最初是为终末期肾病制定的，在过去十年中已扩展到 AKI 领域。尿素动力学模型一直是终末期肾病中剂量量化的主要方法。由于非稳态导致尿素生成率的可变增加、全身水量及其区室分布的改变以及肾脏排泄能力的变化，这些技术在伴有 AKI 的重症患者中进行推断非常困难。当考虑不同透析模式的剂量时，还会面临额外的挑战，这些模式在操作特性（扩散、对流和吸附）、持续时间（间歇性和连续性）和频率方面存在差异。本文旨在回顾透析剂量的概念，对 AKI 中透析剂量的重要临床试验进行批判性评估，总结这些试验的临床证据，并确定未来应解决的关键研究问题。
