切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

中华重症医学电子杂志 ›› 2017, Vol. 03 ›› Issue (01) : 69 -72. doi: 10.3877/cma.j.issn.2096-1537.2017.01.015

所属专题: 重症医学 文献

专题笔谈

急性肾损伤患者肾替代治疗时机:宜早宜晚?
张文筱1, 秦秉玉1,()   
  1. 1. 450000 郑州,河南省人民医院重症医学部
  • 收稿日期:2016-12-28 出版日期:2017-02-28
  • 通信作者: 秦秉玉

Timing of initiation of renal replacement therapy in critically ill patients with acute kidney injury: early or late?

Wenxiao Zhang1, Bingyu Qin1,()   

  1. 1. Department of Intensive Care, Henan Provincial People’s Hospital, Zhengzhou 450000, China
  • Received:2016-12-28 Published:2017-02-28
  • Corresponding author: Bingyu Qin
  • About author:
    Qin Bingyu, Email:
引用本文:

张文筱, 秦秉玉. 急性肾损伤患者肾替代治疗时机:宜早宜晚?[J]. 中华重症医学电子杂志, 2017, 03(01): 69-72.

Wenxiao Zhang, Bingyu Qin. Timing of initiation of renal replacement therapy in critically ill patients with acute kidney injury: early or late?[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2017, 03(01): 69-72.

急性肾损伤(acute kidney injury,AKI)是重症患者常见严重并发症之一,是影响患者死亡的重要因素。尽管肾替代治疗(renal replacement therapy,RRT)对于危及生命情况的抢救治疗的指征已经很明确,但对于并非危及生命的AKI何时进行RRT的最佳时机仍无定论。本文结合最新的ELAIN研究和AKIKI研究的不同点、优缺点,旨在总结AKI患者启动RRT合适的时机。

Acute kidney injury (AKI) is a well-recognized complication of critical illness with a large effect on mortality. Although the indications of renal replacement therapy (RRT) in patients with life-threatening complications are unequivocal, the timing of RRT initiation in patients with severe AKI without such complications has not yet been defined. Two recently large randomized controlled trials (RCT) may provide new evidence of initiation of RRT. The aim of this paper is to analyze the main differences, strengths and limitations of ELAIN and AKIKI study and to finally point out the timing of RRT initiation.

表1 ELAIN和AKIKI研究主要不同点比较
[1]
Clec′h C, Gonzalez F, Lautrette A, et al. Multiple-center evaluation of mortality associated with acute kidney injury in critically ill patients: a competing risks analysis[J]. Crit Care, 2011, 15(3): R128.
[2]
Leite T T, Macedo E, Pereira S M, et al. Timing of renal replacement therapy initiation by AKIN classification system[J]. Crit Care, 2013, 17(2): R62.
[3]
Khwaja A, KDIGO. clinical practice guidelines for acute kidney injury[J]. Nephron Clin Pract, 2012, 120(4): c179–c184.
[4]
Zarbock A, Kellum JA, Schmidt C, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in criticallyill patients with acute kidney injury: the ELAIN randomized clinical trial[J]. JAMA, 2016, 315(20): 2190–2199.
[5]
Gaudry S, Hajage D, Schortgen F, et al. Initiationstrategies for renal-replacement therapy in the intensive care unit[J]. N Engl J Med, 2016, 375(2): 122–133.
[6]
郭东晨, 李昂, 段美丽. 急性肾损伤患者肾脏替代治疗时机的研究进展[J]. 中华危重病急救医学, 2016, 28(3): 285–288.
[7]
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[J]. Crit Care Med, 2002, 30(10): 2205–2211.
[8]
Payen D, Mateo J, Cavaillon JM, et al. Impact of continuous venovenous hemofiltration on organ failure during the early phase of severe sepsis: a randomized controlled trial[J]. Crit Care Med, 2009, 37(3): 803–810.
[9]
Sugahara S, Suzuki H. Early start on continuous hemodialysis therapy improves survival rate in patients with acute renal failure following coronary bypass surgery[J]. Hemodial Int, 2004, 8(4): 320–325.
[10]
Wald R, Adhikari NK, Smith OM, et al. Comparison of standard and accelerated initiation of renal replacement therapy in acute kidney injury[J]. Kidney Int, 2015, 88(4): 897–904.
[11]
Karvellas CJ, Farhat MR, Sajjad I, et al. A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis[J]. Crit Care, 2011, 15(1): R72.
[12]
Vinsonneau C, Allain-Launay E, Blayau C, et al. Renal replacement therapy in adult and pediatric intensive care: recommendations by an expert panel from the French Intensive Care Society (SRLF) with the French Society of Anesthesia Intensive Care (SFAR) French Group for Pediatric Intensive Care Emergencies (GFRUP) the French Dialysis Society (SFD)[J]. Ann Intensive Care, 2015, 5(1): 58.
[13]
Romagnoli S, Ricci Z. When to start a renal replacement therapy in acute kidney injury (AKI) patients: many irons in the fire[J]. Ann Transl Med, 2016, 4(18): 355.
[14]
Coca SG, Zabetian A, Ferket BS, et al. Evaluation of short-term changes in serum creatinine level as a meaningful end point in randomized clinical trials[J]. J Am Soc Nephrol, 2016, 27(8): 2529–2542.
[15]
Barbar SD, Binquet C, Monchi M, et al. Impact on mortality of the timing of renal replacement therapy in patients with severe acute kidney injury in septic shock: the IDEAL-ICU study (initiation of dialysis early versus delayed in the intensive care unit): study protocol for a randomized controlled trial[J]. Trials, 2014, 15: 270.
[16]
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[J]. Trials, 2013, 14: 320.
[17]
Ostermann M, Joannidis M, Pani A, et al. Patient selection and timing of continuous renal replacement therapy[J]. Blood Purif, 2016, 42(3): 224–237.
[18]
Cruz DN, de Geus HR, Bagshaw SM. Biomarker strategies to predict need for renal replacement therapy in acute kidney injury[J]. Semin Dial, 2011, 24(2): 124–131.
[19]
de Geus HR, Bakker J, Lesaffre EM, et al. Neutrophil gelatinase-associated lipocalin at ICU admission predicts for acute kidney injury in adult patients[J]. Am J Respir Crit Care Med, 2011, 183(7): 907–914.
[1] 韩圣瑾, 周正武, 翁云龙, 黄鑫. 碳酸氢钠林格液联合连续性肾脏替代疗法对创伤合并急性肾损伤患者炎症水平及肾功能的影响[J]. 中华危重症医学杂志(电子版), 2023, 16(05): 376-381.
[2] 张秋彬, 张楠, 林清婷, 徐军, 朱华栋, 姜辉. 急性胰腺炎合并急性肾损伤患者的预后评估[J]. 中华危重症医学杂志(电子版), 2023, 16(05): 382-389.
[3] 莫小乔, 胡喆莹, 廖冬花, 谢天. 脓毒症继发急性肾损伤患者死亡风险预测模型构建及评估[J]. 中华危重症医学杂志(电子版), 2023, 16(03): 198-206.
[4] 吴庆华, 冒勇, 闫效坤. AECOPD并发AKI的危险因素分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 529-531.
[5] 李青霖, 宋仁杰, 周飞虎. 一种重型劳力性热射病相关急性肾损伤小鼠模型的建立与探讨[J]. 中华肾病研究电子杂志, 2023, 12(05): 265-270.
[6] 任加发, 邬步云, 邢昌赢, 毛慧娟. 2022年急性肾损伤领域基础与临床研究进展[J]. 中华肾病研究电子杂志, 2023, 12(05): 276-281.
[7] 李金璞, 饶向荣. 抗病毒药物和急性肾损伤[J]. 中华肾病研究电子杂志, 2023, 12(05): 287-290.
[8] 宋艳琪, 任雪景, 王文娟, 韩秋霞, 续玥, 庄凯婷, 肖拓, 蔡广研. 间充质干细胞对顺铂诱导的小鼠急性肾损伤中细胞铁死亡的作用[J]. 中华肾病研究电子杂志, 2023, 12(04): 187-193.
[9] 程庆砾. 新冠病毒感染与肾脏[J]. 中华肾病研究电子杂志, 2023, 12(04): 240-240.
[10] 苗软昕, 乔晞. Toll样受体在脓毒症性急性肾损伤中的作用[J]. 中华肾病研究电子杂志, 2023, 12(04): 210-214.
[11] 李娜, 朱国贞. 肠道菌群及其代谢产物在急性肾损伤中的作用研究进展[J]. 中华肾病研究电子杂志, 2023, 12(04): 215-219.
[12] 任国华, 杜晓晓, 洪善玲, 邵帅. 妊娠期高血压并发急性肾损伤患者血清白细胞介素-22、硫化氢及护骨素水平的变化与意义[J]. 中华肾病研究电子杂志, 2023, 12(03): 150-155.
[13] 于天宇, 杨悦, 陆海涛, 田志永, 李文歌. 高龄急性肾损伤患者连续性肾脏替代治疗的预后及影响因素[J]. 中华肾病研究电子杂志, 2023, 12(03): 134-138.
[14] 王蕤, 乔晞. 重症监护室发生急性肾损伤的危险因素[J]. 中华肾病研究电子杂志, 2023, 12(02): 93-96.
[15] 易成, 韦伟, 赵宇亮. 急性肾脏病的概念沿革[J]. 中华临床医师杂志(电子版), 2023, 17(08): 906-910.
阅读次数
全文


摘要