Beaubien-Souligny William, Bastin Melissa Thompson, Teixeira J Pedro, Cerda Jorge, Connor Michael J, Zeidman Amanda Dijanic, Garimella Pranav S, Juncos Luis, Lopez-Ruiz Arnaldo, Mehta Ravindra, Reis Thiago, Rizo-Topete Lilia, Silver Samuel A, Da Silva J Ricardo, Speer Rajesh, Vijayan Anitha, Wells Catherine, Wille Keith, Yessayan Lenar, Tolwani Ashita, Neyra Javier A
Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada.
Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy.
Kidney360. 2025 Aug 8. doi: 10.34067/KID.0000000951.
In this second installment of the proceedings of the University of Alabama at Birmingham Continuous Renal Replacement Therapy (CRRT) Academy, we focus on the topic of transitions of care in acute RRT. Though we have accumulated data from thousands of critically ill patients with acute kidney injury (AKI) randomized to different strategies for RRT initiation, no trial data exist to guide de-escalation of RRT in the intensive care unit. However, for survivors of severe AKI whose kidney function does not recovery rapidly enough to allow for liberation directly from CRRT, successful de-escalation of care requires the transition from CRRT to intermittent RRT modalities. These transition periods must be carefully navigated since they can be a source of complications, such as failure to transition or intra-dialytic hypotension, which are in turn associated with an increased risk of mortality and reduced odds of kidney recovery. In this review, we focus on the critical factors to consider during de-escalation of RRT care, with a focus on modality transition, the role of volume status in guiding the approach to de-escalation of RRT, and the vital importance of careful dosing of drugs, especially antimicrobial agents, during this transitional period.
在阿拉巴马大学伯明翰分校持续肾脏替代治疗（CRRT）学院会议记录的第二篇文章中，我们聚焦于急性肾脏替代治疗（RRT）中的护理过渡这一主题。尽管我们已经积累了数千例急性肾损伤（AKI）危重症患者随机接受不同RRT起始策略的数据，但尚无试验数据可指导重症监护病房中RRT的降阶梯治疗。然而，对于那些肾功能恢复不够迅速以至于无法直接从CRRT撤机的严重AKI幸存者而言，成功的护理降阶梯需要从CRRT过渡到间歇性RRT模式。这些过渡期必须谨慎应对，因为它们可能是并发症的来源，比如过渡失败或透析中低血压，而这些又反过来与死亡率增加及肾脏恢复几率降低相关。在这篇综述中，我们聚焦于RRT护理降阶梯过程中需要考虑的关键因素，重点关注模式转换、容量状态在指导RRT降阶梯方法中的作用，以及在此过渡期间谨慎调整药物剂量（尤其是抗菌药物）的至关重要性。
