Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Nephron. 2023;147(1):57-60. doi: 10.1159/000525521. Epub 2022 Jul 14.
Acute changes in serum creatinine are labeled clinically as acute kidney injury (AKI). However, not all acute changes in serum creatinine are deleterious and need to be acted upon.
Intravenous fluids in response to AKI should be judiciously administered, and volume overload should be avoided. Since congestion is the driver of poor outcomes in patients with acute decompensated heart failure and must be managed, AKI that occurs at the expense of decongestion does not confer increased risk. We still do not have evidence of therapies that reduce AKI which will translate into any meaningful improvements in clinical outcomes. Finally, particularly in the setting of application of therapies designed to reduce cardiorenal risk, acute changes in serum creatinine are often in the opposite direction of the ultimate clinical outcomes, both renal and nonrenal.
Given the complexities and the nuance of acute changes in serum creatinine, it has ruled itself as an unreliable surrogate for randomized controlled trials and often hinders appropriate care in the clinical setting.
血清肌酐的急性变化临床上被标记为急性肾损伤（AKI）。然而，并非所有血清肌酐的急性变化都是有害的，都需要采取措施。
对于 AKI，应谨慎给予静脉补液，避免容量超负荷。由于充血是急性失代偿性心力衰竭患者预后不良的驱动因素，必须加以管理，因此以消除充血为代价发生的 AKI 不会增加风险。我们仍然没有减少 AKI 的治疗方法的证据，这些方法将转化为临床结局的任何有意义的改善。最后，特别是在应用旨在降低心肾风险的治疗方法的情况下，血清肌酐的急性变化通常与最终的临床结局（肾脏和非肾脏）相反。
鉴于血清肌酐急性变化的复杂性和细微差别，它本身就是随机对照试验不可靠的替代指标，并且经常在临床环境中阻碍适当的护理。
