华西医学

华西医学

连续性肾脏替代治疗应用于急性肾损伤的时机选择

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急性肾损伤(acute kidney injury,AKI)可表现为由多种原因造成的肾功能急剧下降,是影响多器官多系统的临床重症,病死率较高。连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)具有血流动力学稳定、有效清除中大分子、改善炎症状态、精确控制容量负荷等多种优势,在 AKI 的救治中发挥着重要作用。受循证医学证据所限,CRRT 治疗 AKI 的开始时机和终止时机一直存在不同观点。该文从 AKI 的定义及分级、CRRT 治疗 AKI 的指征、开始时机及终止时机的选择等方面进行了综述。

Acute kidney injury (AKI) presents as a sharp decline in renal function caused by a variety of reasons. It is a severe clinical challenge affecting multiple organs and multiple systems, with high mortality. Continuous renal replacement therapy (CRRT) plays an important role in the treatment of AKI. Limited by the lack of evidence, the timing of CRRT for AKI remains ambiguous. This article reviews the definition and grading of AKI, the indication and the timing of initiation/termination of CRRT for AKI .

关键词: 急性肾损伤; 连续性肾脏替代治疗; 时机选择

Key words: Acute kidney injury; Continuous renal replacement therapy; Timing

引用本文: 赵宇亮, 买红霞, 付平. 连续性肾脏替代治疗应用于急性肾损伤的时机选择. 华西医学, 2018, 33(7): 806-809. doi: 10.7507/1002-0179.201806152 复制

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1. Bellomo R, Ronco C, Kellum JA, et al. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care, 2004, 8(4): R204-R212.
2. Hoste EA, Clermont G, Kersten A, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care, 2006, 10(3): R73.
3. Uchino S, Bellomo R, Goldsmith D, et al. An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med, 2006, 34(7): 1913-1917.
4. Coca SG, Yalavarthy R, Concato J, et al. Biomarkers for the diagnosis and risk stratification of acute kidney injury: a systematic review. Kidney Int, 2008, 73(9): 1008-1016.
5. Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA, 2005, 294(7): 813-818.
6. 赵宇亮, 张凌, 付平. 脓毒症急性肾损伤发病机制和诊断治疗的新认识. 中华内科杂志, 2014, 53(1): 70-73.
7. 付平. 连续性肾脏替代治疗. 北京: 人民卫生出版社, 2016.
8. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl, 2012, 2(1): 1-138.
9. 赵宇亮, 张凌, 付平. 提高肾脏病整体预后工作组急性肾损伤临床实践指南热点解读. 中华内科杂志, 2012, 51(12): 935-939.
10. Bouman CS, Oudemans-Van Straaten HM, Tijssen JG, et al. Effects of early high-volume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: a prospective, randomized trial. Crit Care Med, 2002, 30(10): 2205-2211.
11. Combes A, Bréchot N, Amour J, et al. Early high-volume hemofiltration versus standard care for post-cardiac surgery shock. The HEROICS study. Am J Respir Crit Care Med, 2015, 192(10): 1179-1190.
12. 何青莲, 张凌, 付平, 等. CRRT 介入时机与重症急性肾损伤患者预后关系的初步探讨. 中国中西医结合肾病杂志, 2015, 16(10): 877-880.
13. Wierstra BT, Kadri S, Alomar S, et al. The impact of " early” versus " late” initiation of renal replacement therapy in critical care patients with acute kidney injury: a systematic review and evidence synthesis. Crit Care, 2016, 20(1): 122.
14. Gaudry S, Hajage D, Schortgen F, et al. Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med, 2016, 375(2): 122-133.
15. Zarbock A, Kellum JA, Schmidt C, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury the ELAIN randomized clinical trial. JAMA, 2016, 315(20): 2190-2199.
16. Romagnoli S, Clark WR, Ricci Z, et al. Renal replacement therapy for AKI: When? How much? When to stop?. Best Pract Res Clin Anaesthesiol, 2017, 31(3): 371-385.
17. Lai TS, Shiao CC, Wang JJ, et al. Earlier versus later initiation of renal replacement therapy among critically ill patients with acute kidney injury: a systematic review and meta-analysis of randomized controlled trials. Ann Intensive Care, 2017, 7(1): 38.
18. Perez-Fernandez X, Sabater-Riera J, Sileanu F, et al. Clinical variables associated with poor outcome from sepsis-associated acute kidney injury and the relationship with timing of initiation of renal replacement therapy. J Crit Care, 2017, 40: 154-160.
19. Smith OM, Wald R, Adhikari NK, et al. Standard versus accelerated initiation of renal replacement therapy in acute kidney injury (STARRT-AKI): study protocol for a randomized controlled trial. Trials, 2013, 14: 320.
20. Liu KD, Brakeman PR. Renal repair and recovery. Crit Care Med, 2008, 36(4, S): S187-S192.
21. Wu VC, Ko WJ, Chang HW, et al. Risk factors of early redialysis after weaning from postoperative acute renal replacement therapy. Intensive Care Med, 2008, 34(1): 101-108.
22. Uchino S, Bellomo R, Morimatsu H, et al. Discontinuation of continuous renal replacement therapy: a post hoc analysis of a prospective multicenter observational study. Crit Care Med, 2009, 37(9): 2576-2582.
23. Aniort J, Hssain AA, Pereira B, et al. Daily urinary urea excretion to guide intermittent hemodialysis weaning in critically ill patients. Crit Care, 2016, 20: 43.
24. Froehlich S, Donnelly A, Solymos O, et al. Use of 2-hour creatinine clearance to guide cessation of continuous renal replacement therapy. J Crit Care, 2012, 27(6): 744.e1-744.e5.
25. VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med, 2008, 359(1): 7-20.
26. Viallet N, Brunot V, Kuster N, et al. Daily urinary creatinine predicts the weaning of renal replacement therapy in ICU acute kidney injury patients. Ann Intensive Care, 2016, 6(1): 71.
27. Ostermann M, Joannidis M, Pani A, et al. Patient selection and timing of continuous renal replacement therapy. Blood Purif, 2016, 42(3): 224-237.