Department of Critical Care Medicine, University of Calgary, South Health Campus Intensive Care Unit, 4448 Front Street SE, Calgary, AB, T3M 1M4, Canada.
Can J Anaesth. 2019 May;66(5):593-604. doi: 10.1007/s12630-019-01306-x. Epub 2019 Feb 6.
Acute kidney injury (AKI) is defined as an abrupt decrease in kidney function, with the most severe form requiring some method of renal replacement therapy (RRT). The use of RRT is required in 5-10% of critically ill patients who develop severe AKI. Renal replacement therapy can be provided as either intermittent hemodialysis or one of the various modes of continuous renal replacement therapy (CRRT), with CRRT potentially conferring an advantage with respect to renal recovery and dialysis independence. There is no difference in mortality when comparing low (< 25 mL·kg·hr) vs high (> 40 mL·kg·hr) RRT dosing. Continuous renal replacement therapy may be run in different modes of increasing complexity depending on a given patient's clinical needs. Regional citrate anticoagulation is recommended as the therapy of choice for the majority of critically ill patients requiring CRRT.
急性肾损伤（AKI）被定义为肾功能的突然下降，最严重的形式需要某种肾脏替代治疗（RRT）。在发生严重 AKI 的重症患者中，有 5-10%需要使用 RRT。肾脏替代治疗可以是间歇性血液透析或各种连续肾脏替代治疗（CRRT）模式之一，CRRT 可能在肾功能恢复和透析独立性方面具有优势。比较低（< 25 mL·kg·hr）与高（> 40 mL·kg·hr）RRT 剂量时，死亡率没有差异。根据特定患者的临床需求，连续肾脏替代治疗可以以不同的复杂模式运行。大多数需要 CRRT 的重症患者推荐使用局部枸橼酸抗凝作为首选治疗方法。
