Davenport Andrew
Centre for Nephrology, University College London Medical School Royal Free Campus, Rowland Hill Street, London NW3 2PF UK.
F1000 Med Rep. 2010 May 11;2:33. doi: 10.3410/M2-33.
Traditionally, the dose of haemodialysis or haemofiltration delivered to patients with kidney failure is assessed by urea clearance. For patients with chronic kidney disease below a critical urea clearance threshold, patient wellbeing is compromised. It was suggested, therefore, that the dose of dialysis or haemofiltration delivered could also affect outcomes for patients with acute kidney injury. Two major prospective multicentre clinical trials have recently reported that a higher intensity of renal support, by either intermittent haemodialysis or continuous renal replacement therapy, did not improve patient survival or recovery from dialysis. It must be recognised, however, that urea clearance is only one component of renal supportive therapy, and other aspects, including volume control, electrolyte homeostasis and acid-base balance, may be equally important targets for patients with acute kidney injury.
传统上，通过尿素清除率来评估输送给肾衰竭患者的血液透析或血液滤过剂量。对于慢性肾病患者，若尿素清除率低于临界阈值，患者的健康状况会受到损害。因此，有人提出，所给予的透析或血液滤过剂量也可能影响急性肾损伤患者的治疗结果。最近有两项大型前瞻性多中心临床试验报告称，无论是通过间歇性血液透析还是连续性肾脏替代疗法进行更高强度的肾脏支持，均未改善患者生存率或透析后的恢复情况。然而，必须认识到，尿素清除率只是肾脏支持治疗的一个组成部分，而其他方面，包括容量控制、电解质平衡和酸碱平衡，对于急性肾损伤患者可能同样是重要的治疗目标。
