Division of Nephrology and Hypertension, Department of Internal Medicine, Medical School Hannover, Hannover, Germany.
J Nephrol. 2010 Sep-Oct;23(5):494-501.
On September 11, 1945, Maria Schafstaat was the first patient who successfully underwent a dialysis treatment for acute kidney injury (AKI). The ingenious design of the first dialysis machine, made of cellophane tubing wrapped around a cylinder that rotated in a bath of fluid, together with the brave determination to treat patients with AKI, enabled the Dutch physician W.J. Kolff to save the life of the 67-year-old woman. By treating her for 690 minutes (i.e., 11.5 hours) with a blood flow rate of 116 ml/min, Kolff also set the coordinates of a renal replacement therapy that has enjoyed an unsurpassed renaissance over the last decade for treatment of severely ill patients with AKI in the intensive care unit (ICU). Prolonged dialysis time with low flow rates - these days, called extended dialysis (ED) - combines several advantages of both intermittent and continuous techniques, which makes it an ideal treatment method for ICU patients with AKI. This review summarizes our knowledge of this method, which is increasingly used in many centers worldwide. We reflect on prospective controlled studies in critically ill patients that have documented that small-solute clearance with ED is comparable with that of intermittent hemodialysis and continuous venovenous hemofiltration, as well as on studies showing that patients' cardiovascular stability during ED is similar to that with continuous renal replacement therapy. Furthermore, we report on logistic and economic advantages of this method. We share our view on how extended dialysis offers ample opportunity for a collaborative interaction between nephrologists and intensivists as the nephrology staff, enabling optimal treatment of complex critically ill patients by using the skill and knowledge of 2 indispensable specialties in the ICU. Lastly, we address the problem of ED intensity, which does not seem to have an impact on survival at higher doses, a finding that might be caused by the fact that we still adhere to dosing guidelines for antibiotics which are at best ineffectual but might also lead to potentially dangerous underdosing of these life-saving drugs.
1945 年 9 月 11 日，玛丽亚·沙夫斯泰特（Maria Schafstaat）成为首位成功接受透析治疗急性肾损伤（AKI）的患者。荷兰医生 W.J.科尔夫（W.J. Kolff）设计的第一台透析机巧妙地使用玻璃纸管缠绕在一个圆柱体上，圆柱体在充满液体的浴槽中旋转，再加上他治疗 AKI 患者的坚定决心，成功挽救了这位 67 岁女性的生命。科尔夫通过以 116ml/min 的血流速度为她治疗 690 分钟（即 11.5 小时），也为肾替代治疗设定了坐标，这种治疗方法在过去十年中为重症监护病房（ICU）中患有 AKI 的重病患者带来了前所未有的复兴。延长透析时间和低流速——如今被称为延长透析（ED）——结合了间歇性和连续性技术的几个优势，使其成为 ICU 中 AKI 患者的理想治疗方法。这篇综述总结了我们对这种方法的认识，这种方法在世界上许多中心越来越多地被使用。我们回顾了在危重病患者中进行的前瞻性对照研究，这些研究记录了 ED 时小分子清除率与间歇性血液透析和连续静脉-静脉血液滤过相当，以及表明患者在 ED 期间心血管稳定性与连续肾脏替代治疗相似的研究。此外，我们还报告了这种方法的逻辑和经济优势。我们分享了这样一种观点，即延长透析为肾病学家和重症监护医生之间提供了充分的协作机会，使肾病科工作人员能够利用 ICU 中两个不可或缺的专业的技能和知识，为复杂的重症患者提供最佳治疗。最后，我们讨论了 ED 强度的问题，在更高剂量下，它似乎对生存率没有影响，这一发现可能是由于我们仍然坚持使用抗生素剂量指南，这些指南要么无效，要么可能导致这些救命药物潜在的用药不足。
