Department of Intensive Care, Austin Health, Heidelberg, Vic 3084, Australia.
Nat Rev Nephrol. 2010 Sep;6(9):521-9. doi: 10.1038/nrneph.2010.100. Epub 2010 Jul 20.
Continuous renal replacement therapy (CRRT) is the preferred treatment for acute kidney injury (AKI) in intensive care units (ICUs) throughout much of the developed world. Despite its widespread use, however, no formal proof exists that patient outcomes are improved when CRRT is used in preference to intermittent hemodialysis (IHD). In addition, controversy and center-specific practice variation in the clinical application of CRRT continues, owing to a lack of randomized multicenter studies of both CRRT and IHD providing level 1 data to inform clinical practice. Now, however, the publication of results from the Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network (ATN) study and the Randomized Evaluation of Normal versus Augmented Level Renal Replacement Therapy (RENAL) trial have provided an unparalleled quantity of information to guide clinicians. These pivotal trials investigated different intensities of CRRT in the ICU and provided level 1 evidence that effluent flow rates >25 ml/kg per hour do not improve outcomes in patients in the ICU. In this Review, we discuss the background and results of the ATN and RENAL trials and the emerging consensus that CRRT is the most appropriate treatment for AKI in vasopressor-dependent patients in the ICU. Finally, we describe the remaining controversies regarding the use of CRRT and the questions that remain to be answered.
连续肾脏替代疗法（CRRT）是重症监护病房（ICU）中急性肾损伤（AKI）的首选治疗方法，在许多发达国家都得到广泛应用。然而，尽管CRRT 得到广泛应用，但尚无确凿证据表明，与间歇性血液透析（IHD）相比，使用 CRRT 可改善患者结局。此外，由于缺乏 CRRT 和 IHD 的随机多中心研究提供 1 级数据来指导临床实践，因此 CRRT 的临床应用仍存在争议和中心特异性实践差异。如今，退伍军人事务部/美国国立卫生研究院急性肾衰竭试验网络（ATN）研究和随机评估正常与增强水平肾脏替代治疗（RENAL）试验的结果公布，为指导临床医生提供了前所未有的大量信息。这两项关键性试验在 ICU 中研究了不同强度的 CRRT，并提供了 1 级证据，表明每小时超过 25ml/kg 的流出液速率并不能改善 ICU 患者的结局。在这篇综述中，我们讨论了 ATN 和 RENAL 试验的背景和结果，以及目前的共识，即 CRRT 是 ICU 中依赖血管加压素的 AKI 患者最恰当的治疗方法。最后，我们描述了关于 CRRT 使用的尚存争议和有待回答的问题。
