Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, Florida.
J Am Coll Cardiol. 2020 Sep 1;76(9):1084-1101. doi: 10.1016/j.jacc.2020.06.070.
Acute kidney injury (AKI) and cardiorenal syndrome (CRS) are increasingly prevalent in hospitalized patients with cardiovascular disease and remain associated with poor short- and long-term outcomes. There are no specific therapies to reduce mortality related to either AKI or CRS, apart from supportive care and volume status management. Acute renal replacement therapies (RRTs), including ultrafiltration, intermittent hemodialysis, and continuous RRT are used to manage complications of medically refractory AKI and CRS and may restore normal electrolyte, acid-base, and fluid balance before renal recovery. Patients who require acute RRT have a significant risk of mortality and long-term dialysis dependence, emphasizing the importance of appropriate patient selection. Despite the growing use of RRT in the cardiac intensive care unit, there are few resources for the cardiovascular specialist that integrate the epidemiology, diagnostic workup, and medical management of AKI and CRS with an overview of indications, multidisciplinary team management, and transition off of RRT.
急性肾损伤 (AKI) 和心肾综合征 (CRS) 在患有心血管疾病的住院患者中越来越普遍，并且仍然与短期和长期预后不良相关。除了支持性护理和容量状态管理外，目前尚无专门的治疗方法可以降低与 AKI 或 CRS 相关的死亡率。急性肾脏替代疗法 (RRT)，包括超滤、间歇性血液透析和连续 RRT，用于治疗医学上难治性 AKI 和 CRS 的并发症，并在肾功能恢复前恢复正常的电解质、酸碱和液体平衡。需要急性 RRT 的患者有很高的死亡率和长期透析依赖的风险，这强调了适当选择患者的重要性。尽管 RRT 在心脏重症监护病房中的使用越来越多，但心血管专家的资源很少，这些资源将 AKI 和 CRS 的流行病学、诊断评估和医学管理与适应症概述、多学科团队管理和 RRT 脱机整合在一起。
