Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN, USA.
Blood Purif. 2017;44(2):140-155. doi: 10.1159/000475457. Epub 2017 Jun 7.
BACKGROUND/AIMS: Delivered dialysis therapy is routinely measured in the management of patients with end-stage renal disease; yet, the quantification of renal replacement prescription and delivery in acute kidney injury (AKI) is less established. While continuous renal replacement therapy (CRRT) is widely understood to have greater solute clearance capabilities relative to intermittent therapies, neither urea nor any other solute is specifically employed for CRRT dose assessments in clinical practice at present. Instead, the normalized effluent rate is the gold standard for CRRT dosing, although this parameter does not provide an accurate estimation of actual solute clearance for different modalities.
Because this situation has created confusion among clinicians, we reappraise dose prescription and delivery for CRRT.
A critical review of RRT quantification in AKI is provided.
We propose an adaptation of a maintenance dialysis parameter (standard Kt/V) as a benchmark to supplement effluent-based dosing of CRRT. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=475457.
背景/目的：在终末期肾病患者的管理中，常规测量提供的透析治疗；然而，急性肾损伤（AKI）中肾替代治疗方案的量化和实施还不太明确。虽然连续肾脏替代治疗（CRRT）相对于间歇性治疗具有更大的溶质清除能力，但目前在临床实践中，既没有尿素也没有任何其他溶质专门用于 CRRT 剂量评估。相反，标准化的流出液速率是 CRRT 剂量的金标准，尽管该参数并不能为不同模式提供实际溶质清除的准确估计。
由于这种情况给临床医生造成了困惑，我们重新评估 CRRT 的剂量方案和实施。
提供了对 AKI 中 RRT 量化的批判性回顾。
我们建议采用维持性透析参数（标准 Kt/V）作为基准，以补充基于流出液的 CRRT 剂量。视频期刊俱乐部“克劳迪奥·隆科的卡布奇诺”，网址：http://www.karger.com/?doi=475457。
