Department of Critical Care and Surrey Peri-Operative, Anaesthesia and Critical Care Collaborative Research Group, Royal Surrey Hospital, Guildford, Surrey, UK.
Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Austria.
Curr Opin Crit Care. 2023 Dec 1;29(6):559-565. doi: 10.1097/MCC.0000000000001101. Epub 2023 Sep 26.
Acute kidney injury is common in intensive care patients. Supportive care involves the use of renal replacement therapies as organ support. Initiation of renal replacement therapy has been the subject of much interest over the last few years with several randomised controlled studies examining the optimal time to commence treatment. In contrast to this, little evidence has been generated regarding cessation of therapy. Given that this treatment is complex, not without risk and expensive it seems timely that efforts should be expended at examining this vexing issue.
Although several studies have been reported examining the successful discontinuation of renal replacement therapies all studies reported to-date are observational in nature. Conventional biochemical criteria have been used as well as physiological parameters including urine output. More recently, more novel biomarkers of renal function have been studied. Although to-date no optimal variable nor threshold for discontinuation can be established.
Several variables have been described which may have a role in determining which patients may be successfully weaned from renal replacement therapy. However, few have been exposed to vigorous examination and evidence is sparse in support of any potential approach although urine output currently is the most often described. More recently novel biomarkers have also been examined but again are limited by study design and heterogeneity. Further research is clearly needed focussing on proposed variables preferably in multivariate models to improve predictive ability and successful cessation of therapy.
急性肾损伤在重症监护患者中很常见。支持性治疗包括使用肾脏替代疗法作为器官支持。在过去的几年中，人们对开始肾脏替代治疗的最佳时机进行了大量研究，这引起了广泛关注。相比之下，关于停止治疗的证据很少。鉴于这种治疗方法复杂、有风险且昂贵，似乎应该及时研究这个棘手的问题。
尽管已经报道了几项关于成功停止肾脏替代治疗的研究，但迄今为止所有报告的研究都是观察性的。常规生化指标以及包括尿量在内的生理参数都被使用。最近，更多新型肾功能生物标志物也被研究。尽管迄今为止，尚未确定最佳的变量或停止治疗的阈值。
已经描述了几个可能有助于确定哪些患者可以成功脱离肾脏替代治疗的变量。然而，很少有变量受到严格检查，尽管目前尿量是最常描述的，但几乎没有证据支持任何潜在的方法。最近也研究了新型生物标志物，但由于研究设计和异质性的限制，它们同样受到限制。显然需要进一步研究，最好是在多变量模型中研究拟议的变量，以提高预测能力并成功停止治疗。
