Murray Patrick, Udani Suneel, Koyner Jay L
Contrib Nephrol. 2011;174:212-221. doi: 10.1159/000329399. Epub 2011 Sep 9.
All aspects of current treatment of acute kidney injury (AKI), including renal replacement therapy (RRT), are basically supportive. Emergent RRT is indicated in the management of AKI with refractory pulmonary edema, hyperkalemia or metabolic acidosis, or when uremic symptoms or signs develop. More aggressive practitioners use prophylactic RRT inpatients with sustained anuria, persistent oliguria with progressive azotemia and a probable glomerular filtration rate < 10 ml/min, or to prevent uncontrolled positive fluid balance in patients with AKI. However, this approach to RRT initiation in AKI is largely supported by retrospective analyses rather than prospective clinical trials. The approach to RRT dosing in AKI is more evidence-based. Outcomes in single-center studies of higher intensity versus standard RRT (intermittent and/or continuous) have been in consistent. However, two large multicenter negative randomized trials have shifted the weight of evidence towards suggesting provision of an effectively delivered standard dose of RRT in AKI, rather than seeking to increase RRT intensity.
急性肾损伤（AKI）当前治疗的所有方面，包括肾脏替代治疗（RRT），基本上都是支持性的。对于伴有难治性肺水肿、高钾血症或代谢性酸中毒的AKI患者，或者出现尿毒症症状或体征时，需要进行紧急RRT。更积极的医生会对持续无尿、伴有进行性氮质血症的持续性少尿且可能肾小球滤过率<10 ml/min的住院患者使用预防性RRT，或者用于预防AKI患者出现失控的正液体平衡。然而，这种在AKI中启动RRT的方法很大程度上是基于回顾性分析，而非前瞻性临床试验。AKI中RRT剂量的确定方法更具循证性。关于高强度与标准RRT（间歇性和/或连续性）的单中心研究结果并不一致。然而，两项大型多中心阴性随机试验已将证据权重转向表明在AKI中应提供有效给予的标准剂量RRT，而非试图增加RRT强度。
