Klein S J, Joannidis M
Gemeinsame Einrichtung internistische Intensiv- und Notfallmedizin, Department für Innere Medizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
Med Klin Intensivmed Notfmed. 2017 Jun;112(5):437-443. doi: 10.1007/s00063-017-0290-0. Epub 2017 May 2.
Acute kidney injury is still a common complication in intensive care units and is associated with a significantly increased risk for morbidity and mortality. Various treatment concepts, like continuous renal replacement therapy (RRT) or (modified) intermittent procedures, as well as different methods of anticoagulation and the general decision of when and if to initiate RRT have to be considered by the treating physician. While giving vital input on when to initiate RRT, the German ELAIN (Early versus late initiation of renal replacement therapy in critically ill patients) trial and the French AKIKI (The artificial kidney initiation in kidney injury) trial raised many more questions. Currently in its recruiting phase, the STARRT-AKI (Standard versus accelerated initiation of renal replacement therapy in acute kidney injury) trial is designed to hopefully give a definitive statement. Due to a planned recruiting phase until 2019, results are expected in 2020 at the earliest. Regarding the termination of RRT, recurring diuresis of more than 450 ml/24 h is a good indicator for recovery of renal function.
急性肾损伤仍是重症监护病房的常见并发症，且与发病率和死亡率显著增加相关。治疗医师必须考虑各种治疗方案，如连续性肾脏替代治疗（RRT）或（改良）间歇性治疗方法，以及不同的抗凝方法和启动RRT的时机及是否启动的总体决策。德国的ELAIN（危重症患者肾脏替代治疗早期与晚期启动）试验和法国的AKIKI（肾损伤时人工肾启动）试验虽然为启动RRT的时机提供了重要依据，但也引发了更多问题。目前处于招募阶段的STARRT-AKI（急性肾损伤中标准与加速启动肾脏替代治疗）试验旨在有望给出明确结论。由于计划的招募阶段持续到2019年，最早预计2020年得出结果。关于RRT的终止，24小时尿量反复超过450毫升是肾功能恢复的良好指标。
