Nusshag Christian, Weigand Markus A, Zeier Martin, Morath Christian, Brenner Thorsten
Department of Nephrology, Heidelberg University Hospital, 162, Im Neuenheimer Feld, D-69120 Heidelberg, Germany.
Department of Anesthesiology, Heidelberg University Hospital, 110, Im Neuenheimer Feld, D-69120 Heidelberg, Germany.
Int J Mol Sci. 2017 Jun 28;18(7):1387. doi: 10.3390/ijms18071387.
Acute kidney injury (AKI) has a high incidence on intensive care units around the world and is a major complication in critically ill patients suffering from sepsis or septic shock. The short- and long-term complications are thereby devastating and impair the quality of life. Especially in terms of AKI staging, the determination of kidney function and the timing of dialytic AKI management outside of life-threatening indications are ongoing matters of debate. Despite several studies, a major problem remains in distinguishing between beneficial and unnecessary "early" or even harmful renal replacement therapy (RRT). The latter might prolong disease course and renal recovery. AKI scores, however, provide an insufficient outcome-predicting ability and the related estimation of kidney function via serum creatinine or blood urea nitrogen (BUN)/urea is not reliable in AKI and critical illness. Kidney independent alterations of creatinine- and BUN/urea-levels further complicate the situation. This review critically assesses the current AKI staging, issues and pitfalls of the determination of kidney function and RRT timing, as well as the potential harm reflected by unnecessary RRT. A better understanding is mandatory to improve future study designs and avoid unnecessary RRT for higher patient safety and lower health care costs.
急性肾损伤（AKI）在全球重症监护病房中发病率很高，是脓毒症或脓毒性休克重症患者的主要并发症。其短期和长期并发症具有极大破坏性，会损害生活质量。特别是在AKI分期方面，除危及生命的指征外，肾功能的判定以及透析性AKI治疗时机仍是持续争论的问题。尽管有多项研究，但区分有益和不必要的“早期”甚至有害的肾脏替代治疗（RRT）仍是一个主要问题。后者可能会延长病程和肾脏恢复时间。然而，AKI评分的预后预测能力不足，且通过血清肌酐或血尿素氮（BUN）/尿素对肾功能进行的相关评估在AKI和危重病中并不可靠。肌酐和BUN/尿素水平的肾脏非依赖性改变使情况更加复杂。本综述批判性地评估了当前的AKI分期、肾功能判定和RRT时机的问题与陷阱，以及不必要的RRT所反映的潜在危害。为了改进未来的研究设计并避免不必要的RRT以提高患者安全性和降低医疗成本，必须有更好的理解。
