Klingele Matthias, Baerens Lea
Department of Internal Medicine, Nephrology and Hypertension, Saarland University Medical Centre, 66424 Homburg/Saar, Germany.
Department of Nephrology, Hochtaunuskliniken, 61352 Bad Homburg, Germany.
J Clin Med. 2021 Jul 30;10(15):3379. doi: 10.3390/jcm10153379.
Acute kidney injury (AKI) is a common complication in critically ill patients with an incidence of up to 50% in intensive care patients. The mortality of patients with AKI requiring dialysis in the intensive care unit is up to 50%, especially in the context of sepsis. Different approaches have been undertaken to reduce this high mortality by changing modalities and techniques of renal replacement therapy: an early versus a late start of dialysis, high versus low dialysate flows, intermittent versus continuous dialysis, anticoagulation with citrate or heparin, the use of adsorber or special filters in case of sepsis. Although in smaller studies some of these approaches seemed to have a positive impact on the reduction of mortality, in larger studies these effects could not been reproduced. This raises the question of whether there exists any impact of renal replacement therapy on mortality in critically ill patients-beyond an undeniable impact on uremia, hyperkalemia and/or hypervolemia. Indeed, this is one of the essential challenges of a nephrologist within an interdisciplinary intensive care team: according to the individual situation of a critically ill patient the main indication of dialysis has to be identified and all parameters of dialysis have to be individually chosen with respect to the patient's situation and targeting the main dialysis indication. Such an interdisciplinary and individual approach would probably be able to reduce mortality in critically ill patients with dialysis requiring AKI.
急性肾损伤（AKI）是危重症患者常见的并发症，在重症监护患者中的发生率高达50%。在重症监护病房中，需要透析的AKI患者的死亡率高达50%，尤其是在脓毒症的情况下。人们采取了不同方法，通过改变肾脏替代治疗的方式和技术来降低这种高死亡率：透析的早期开始与晚期开始、高透析液流量与低透析液流量、间歇性透析与连续性透析、用枸橼酸盐或肝素进行抗凝、在脓毒症时使用吸附器或特殊滤器。尽管在一些较小规模的研究中，这些方法中的一些似乎对降低死亡率有积极影响，但在规模较大的研究中，这些效果无法重现。这就引发了一个问题，即肾脏替代治疗对危重症患者的死亡率是否有任何影响——除了对尿毒症、高钾血症和/或高血容量有不可否认的影响之外。的确，这是跨学科重症监护团队中肾脏病学家面临的主要挑战之一：根据危重症患者的个体情况，必须确定透析的主要指征，并且必须根据患者的情况并针对主要透析指征，单独选择所有透析参数。这样一种跨学科的个体化方法可能能够降低需要透析的AKI危重症患者的死亡率。
