Department of Critical Care, King's College London, Guy's & St. Thomas' Hospital, London, United Kingdom.
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada.
Clin J Am Soc Nephrol. 2023 Jan 1;18(1):113-120. doi: 10.2215/CJN.05450522. Epub 2022 Sep 13.
KRT is considered for patients with severe AKI and associated complications. The exact indications for initiating KRT have been debated for decades. There is a general consensus that KRT should be considered in patients with AKI and medically refractory complications ("urgent indications"). "Relative indications" are more common but defined with less precision. In this review, we summarize the latest evidence from recent landmark clinical trials, discuss strategies to anticipate the need for KRT in individual patients, and propose an algorithm for decision making. We emphasize that the decision to consider KRT should be made in conjunction with other forms of organ support therapies and important nonkidney factors, including the patient's preferences and overall goals of care. We also suggest future research to differentiate patients who benefit from timely initiation of KRT from those with imminent recovery of kidney function. Until then, efforts are needed to optimize the initiation and delivery of KRT in routine clinical practice, to minimize nonessential variation, and to ensure that patients with persistent AKI or progressive organ failure affected by AKI receive KRT in a timely manner.
KRT 适用于患有严重 AKI 及相关并发症的患者。几十年来，人们一直在争论启动 KRT 的具体适应证。人们普遍认为，对于患有 AKI 且有医学上无法控制的并发症的患者（“紧急适应证”），应考虑 KRT。“相对适应证”更为常见，但定义不够精确。在本综述中，我们总结了最近几项具有里程碑意义的临床试验的最新证据，讨论了预测个体患者需要 KRT 的策略，并提出了决策算法。我们强调，考虑 KRT 的决定应结合其他形式的器官支持治疗和重要的非肾脏因素，包括患者的偏好和整体治疗目标。我们还建议开展未来研究，以区分从那些肾功能即将恢复的患者中受益于及时开始 KRT 的患者。在那之前，需要努力在常规临床实践中优化 KRT 的启动和实施，尽量减少不必要的差异，并确保患有持续 AKI 或受 AKI 影响的进行性器官衰竭的患者能及时接受 KRT。
