Yong Kenneth, Dogra Gursharan, Boudville Neil, Pinder Mary, Lim Wai
Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia.
Int J Nephrol. 2011;2011:762634. doi: 10.4061/2011/762634. Epub 2011 Apr 14.
This paper addresses the epidemiology of AKI specifically in relation to recent changes in AKI classification and revisits the controversies regarding the timing of initiation of dialysis and the use of peritoneal dialysis as a renal replacement therapy for AKI. In summary, the new RIFLE/AKIN classifications of AKI have facilitated more uniform diagnosis of AKI and clinically significant risk stratification. Regardless, the issue of timing of dialysis initiation still remains unanswered and warrants further examination. Furthermore, peritoneal dialysis as a treatment modality for AKI remains underutilised in spite of potential beneficial effects. Future research should be directed at identifying early reliable biomarkers of AKI, which in conjunction with RIFLE/AKIN classifications of AKI could facilitate well-designed large randomised controlled trials of early versus late initiation of dialysis in AKI. In addition, further studies of peritoneal dialysis in AKI addressing dialysis dose and associated complications are required for this therapy to be accepted more widely by clinicians.
本文专门探讨急性肾损伤（AKI）的流行病学，特别是与AKI分类的近期变化相关的内容，并重新审视关于开始透析的时机以及使用腹膜透析作为AKI肾脏替代治疗方法的争议。总之，AKI的新RIFLE/AKIN分类有助于更统一地诊断AKI以及进行具有临床意义的风险分层。尽管如此，透析开始的时机问题仍然没有答案，值得进一步研究。此外，尽管腹膜透析作为AKI的一种治疗方式可能具有有益效果，但仍未得到充分利用。未来的研究应致力于确定AKI早期可靠的生物标志物，结合AKI的RIFLE/AKIN分类，这有助于设计良好的大型随机对照试验，比较AKI早期与晚期开始透析的效果。此外，需要对AKI患者的腹膜透析进行进一步研究，以解决透析剂量和相关并发症问题，以便这种治疗方法能被临床医生更广泛地接受。
