Joannidis Michael
Medical Intensive Care Unit, Department of Internal Medicine I, Medical University Innsbruck, Innsbruck, Austria.
Contrib Nephrol. 2011;174:222-231. doi: 10.1159/000329400. Epub 2011 Sep 9.
The search for the optimal intensity in renal replacement therapy of the critically ill has resulted in several well-designed randomized controlled trials over the last decade. The findings, however, have been somewhat disappointing. Whereas earlier trials indicated a survival benefit using higher doses ( > 35 ml/kg/h) or daily dialysis, more recent and much larger trials have shown that intensities in the range of 20-25 ml/kg/h or alternate day dialysis may be sufficient. This review attempts to explain these discrepant findings by critically reappraising several issues including the concept of dose, comparability of doses, importance of middle molecule clearance, indication and timing of treatment as well as patient heterogeneity between the published studies.
在过去十年中，为寻找危重症患者肾脏替代治疗的最佳强度，开展了多项精心设计的随机对照试验。然而，研究结果却有些令人失望。早期试验表明，采用较高剂量（>35毫升/千克/小时）或每日透析可带来生存益处，而最近规模大得多的试验表明，20 - 25毫升/千克/小时的强度或隔日透析可能就足够了。本综述试图通过严格重新评估几个问题来解释这些相互矛盾的研究结果，这些问题包括剂量概念、剂量的可比性、中分子清除的重要性、治疗指征和时机以及已发表研究之间的患者异质性。
