Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
Nephrol Dial Transplant. 2012 Jul;27(7):2761-7. doi: 10.1093/ndt/gfr740. Epub 2011 Dec 29.
Little is known about factors that influence the timing of initiation of renal replacement therapy (RRT) for acute kidney injury (AKI). We sought to better describe these factors for Canadian physicians that prescribe RRT for AKI.
A web-based survey was conducted of physicians involved in the decision to initiate RRT for critically ill patients in Canada. Participants were asked about the factors that prompt them to initiate RRT for AKI both directly and using scenario-based questions.
Surveys completed by 180 physicians at 32 different sites were included for analysis. Serum potassium level and severity of pulmonary edema were the most commonly utilized factors for deciding when RRT should be started. For all clinical and laboratory factors inquired about, there was wide variation in the minimum severity that prompted respondents to indicate that they would initiate RRT. Additional factors that influenced the timing of initiation were the time-of-day that laboratory and clinical results became available, patient age and co-morbidity, responsiveness to a diuretic challenge and the specialty of the prescribing physician. Over 90% of respondents indicated that a randomized controlled trial to assess the optimal timing of initiation of RRT for AKI is ethically justified.
These results provide insight into clinical and laboratory factors that influence the timing of initiation of RRT for AKI and may aid in the design of future trials. While most clinicians consider the degree of hyperkalemia and pulmonary edema in deciding when to initiate RRT for AKI, there is a wide range of clinical practice, uncertainty regarding the optimal timing of initiation and enthusiasm for prospective interventional studies to address this topic.
对于影响急性肾损伤（AKI）患者开始肾脏替代治疗（RRT）时机的因素知之甚少。我们试图为加拿大为 AKI 开具 RRT 处方的医生更好地描述这些因素。
对加拿大参与决定为重症患者开始 RRT 的医生进行了一项基于网络的调查。参与者被问到直接和使用基于情景的问题促使他们开始 AKI 的 RRT 的因素。
对来自 32 个不同地点的 180 名医生进行的调查进行了分析。血清钾水平和肺水肿严重程度是决定何时开始 RRT 的最常用因素。对于询问的所有临床和实验室因素，促使受访者表示他们将开始 RRT 的最小严重程度存在很大差异。影响开始时机的其他因素包括实验室和临床结果可用的时间、患者年龄和合并症、对利尿剂挑战的反应性以及处方医生的专业。超过 90%的受访者表示，评估 AKI 开始 RRT 的最佳时机的随机对照试验在伦理上是合理的。
这些结果提供了对影响 AKI 开始 RRT 时机的临床和实验室因素的深入了解，并可能有助于未来试验的设计。虽然大多数临床医生在决定何时开始 AKI 的 RRT 时考虑高钾血症和肺水肿的程度，但临床实践存在广泛差异，对开始的最佳时机存在不确定性，并且热衷于前瞻性干预性研究来解决这一问题。
