重新审视急性肾损伤中利尿剂的使用：有效预防还是虚幻希望？
Rethinking diuretic use in acute kidney injury: effective prevention or false hope?
作者信息
Yamada Hiroyuki, Murata Maki, Hashimoto Hiroyuki
机构信息
Department of Primary Care and Emergency, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 6068507, Japan.
Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
出版信息
J Intensive Care. 2025 Jun 16;13(1):34. doi: 10.1186/s40560-025-00804-z.
A recent meta-analysis of randomized controlled trials (with pre-specified methods and the largest sample to date) found that prophylactic diuretics significantly reduce acute kidney injury (AKI) incidence in high-risk patients but provide no benefit in treating established AKI. These findings challenge current AKI management guidelines, which generally discourage prophylactic diuretic use. However, given heterogeneity among trials and some risk of bias, caution is advised before generally altering clinical practice until further research confirms these findings.
最近一项对随机对照试验（采用预先指定的方法且样本量为迄今为止最大）的荟萃分析发现，预防性使用利尿剂可显著降低高危患者急性肾损伤（AKI）的发生率，但对已确诊的AKI治疗并无益处。这些发现对当前的AKI管理指南构成了挑战，该指南通常不鼓励预防性使用利尿剂。然而，鉴于试验之间存在异质性以及一些偏倚风险，在进一步研究证实这些发现之前，建议在普遍改变临床实践时保持谨慎。
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