Cruz-Llanos Luis, Molano Alejandra, Rizo-Topete Lilia
Nephrology Service, National Cardiovascular Institute "Carlos Alberto Peschiera Carrillo", Lima, Peru.
Renal Therapy Service, Cardioinfantil Foundation, Bogotá, Colombia.
Front Nephrol. 2022 Mar 8;2:853677. doi: 10.3389/fneph.2022.853677. eCollection 2022.
Acute brain injury is the sudden and reversible loss of brain self regulation capacity as a disruption of the blood-brain barrier that conditions metabolic and inflammatory disorders that can exacerbate acute kidney injury in a critical setting; specifically it has been described that the alterations of the internal environment that come from the severity of the acute kidney injury increases the risk of endocranial hypertension and cerebral edema; in this context, injuries should be identified and treated in a timely manner with a comprehensive approach. Continuous renal replacement therapy is an extracorporeal purification technique that has been gaining ground in the management of acute kidney injury in critically ill patients. Within its modalities, continuous venous venous hemofiltration is described as the therapy of choice in patients with acute brain injury due to its advantages in maintaining hemodynamic stability and reducing the risk of cerebral edema. Optimal control of variables such as timing to start renal replacement therapy, the prescribed dose, the composition of the replacement fluid and the anticoagulation of the extracorporeal circuit will have a significant impact on the evolution of the neurocritical patient with acute kidney injury. There are limited studies evaluating the role of hemofiltration in this context.
急性脑损伤是指脑自我调节能力的突然且可逆性丧失，这是由于血脑屏障破坏导致代谢和炎症紊乱，在危急情况下可能会加重急性肾损伤；具体而言，已有研究表明，急性肾损伤的严重程度所导致的内环境改变会增加颅内高压和脑水肿的风险；在此背景下，应采用综合方法及时识别并治疗这些损伤。持续肾脏替代疗法是一种体外净化技术，在危重症患者急性肾损伤的管理中越来越受到重视。在其治疗方式中，持续静脉-静脉血液滤过因其在维持血流动力学稳定性和降低脑水肿风险方面的优势，被描述为急性脑损伤患者的首选治疗方法。对开始肾脏替代治疗的时机、规定剂量、置换液成分以及体外循环抗凝等变量的最佳控制，将对急性肾损伤神经危重症患者的病情发展产生重大影响。在这种情况下，评估血液滤过作用的研究有限。
