Bagshaw Sean M, Lamontagne François, Joannidis Michael, Wald Ron
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E Clinical Sciences Building 8440-112 ST, NW, Edmonton, T6G 2B7, Canada.
Centre de Recherche du CHU de Sherbrooke, Sherbrooke, QC, Canada.
Crit Care. 2016 Aug 6;20(1):245. doi: 10.1186/s13054-016-1424-0.
The dilemma of whether and when to start renal replacement therapy among critically ill patients with acute kidney injury in the absence of conventional indications has long been a vexing challenge for clinicians. The lack of high-quality evidence has undoubtedly contributed decisional uncertainty and unnecessary practice variation. Recently, two randomized trials (ELAIN and AKIKI) reported specifically on the issue of the timing of initiation of renal replacement therapy in critically ill patients with acute kidney injury. In this commentary, their fundamental differences in trial design, sample size, and widely discrepant findings are considered in context. While both trials are important contributions towards informing practice on this issue, additional evidence from large multicenter randomized trials is needed.
对于没有传统指征的急性肾损伤危重症患者，是否以及何时开始肾脏替代治疗的困境长期以来一直是临床医生面临的棘手挑战。缺乏高质量证据无疑导致了决策的不确定性和不必要的实践差异。最近，两项随机试验（ELAIN和AKIKI）专门报告了急性肾损伤危重症患者开始肾脏替代治疗的时机问题。在这篇评论中，结合背景考虑了它们在试验设计、样本量和差异巨大的研究结果方面的根本差异。虽然这两项试验对指导该问题的实践都有重要贡献，但仍需要来自大型多中心随机试验的更多证据。
