Neyra Javier A, Mehta Ravindra L, Murugan Raghavan
Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Division of Nephrology, Department of Medicine, University of California San Diego, San Diego, California, USA.
Nephron. 2023;147(12):782-787. doi: 10.1159/000534395. Epub 2023 Oct 4.
Continuous renal replacement therapy (CRRT) is frequently used for fluid management of critically ill patients with acute or chronic kidney failure. There is significant practice variation worldwide in fluid management during CRRT. Multiple clinical studies have suggested that both the magnitude and duration of fluid overload are associated with morbidity and mortality in critically ill patients. Therefore, timely and effective fluid management with CRRT is paramount in managing critically ill patients with fluid overload. While the optimal method of fluid management during CRRT is still unclear and warrants further investigation, observational data have suggested a U-shape relationship between net ultrafiltration rate and mortality. Furthermore, recent clinical data have underpinned a significant gap in prescribed versus achieved fluid balance during CRRT, which is also associated with mortality. This review uses a case-based approach to discuss two fluid management strategies based on net ultrafiltration rate and fluid balance goals during CRRT and harmonizes operational definitions.
连续性肾脏替代治疗（CRRT）常用于急性或慢性肾衰竭危重症患者的液体管理。全球范围内，CRRT期间的液体管理存在显著的实践差异。多项临床研究表明，液体超负荷的程度和持续时间均与危重症患者的发病率和死亡率相关。因此，采用CRRT进行及时有效的液体管理对于治疗液体超负荷的危重症患者至关重要。虽然CRRT期间液体管理的最佳方法仍不明确，有待进一步研究，但观察性数据表明净超滤率与死亡率之间呈U形关系。此外，近期临床数据表明，CRRT期间规定的液体平衡与实际达到的液体平衡之间存在显著差距，这也与死亡率相关。本综述采用基于病例的方法，讨论了基于CRRT期间净超滤率和液体平衡目标的两种液体管理策略，并统一了操作定义。
