Dube Simmi, Sharma V K
Department of Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh.
J Assoc Physicians India. 2009 Oct;57:708-12.
Acute renal failure requiring renal replacement therapy (RRT) is a frequent complication in critically ill patients with high morbidity and mortality. Early prediction of who is going to need RRT is clinically useful in the intensive care unit (ICU). Patients' with diuretic resistant pulmonary edema, hyperkalemia/metabolic acidosis refractory to medical therapy and uremic complications (pericarditis, encephalopathy, bleeding) are candidates who need RRT as an earlier intervention with continuous haemofiltration, which might be beneficial to the patient and even prevent clinicians from implementing unnecessary, futile and perhaps injurious escalations in medical therapy (e.g., low-dose dopamine, mannitol boluses, further fluid loading, introduction of additional vasoactive drugs) to rescue kidneys that are beyond rescuing. Recent evidence also suggests that RRT may be useful as an immunomodulator and best initiated early in the course of the patient's illness with multiple system involvement.
需要肾脏替代治疗（RRT）的急性肾衰竭是危重症患者常见的并发症，发病率和死亡率都很高。在重症监护病房（ICU）中，早期预测哪些患者需要RRT具有临床实用价值。存在利尿剂抵抗性肺水肿、高钾血症/药物治疗难以纠正的代谢性酸中毒以及尿毒症并发症（心包炎、脑病、出血）的患者，是需要早期进行连续性血液滤过RRT干预的对象，这可能对患者有益，甚至能避免临床医生为挽救已无法挽救的肾脏而采取不必要、无效甚至可能有害的医疗治疗升级措施（如小剂量多巴胺、甘露醇推注、进一步补液、使用其他血管活性药物）。近期证据还表明，RRT作为一种免疫调节剂可能有用，且最好在患者病情累及多个系统的病程早期就开始使用。
