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

doi:10.3877/cma.j.issn.2096-1537.2017.01.015

Abstract

Abstract:

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.

Key words: Acute kidney injury, Renal replacement therapy, Therapy timing

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.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2017.01.015

https://icu.cma-cmc.com.cn/EN/Y2017/V03/I01/69

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References 19

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研究者	研究设计方案	纳入标准	启动RRT时机		主要结果指标	主要结果
研究者	研究设计方案	纳入标准	早期组	晚期组	主要结果指标	主要结果
ELAIN研究	单中心RCT	KDIGO分级为2级，并且NGAL >150 ng/ml	入组后8 h内，所有患者行RRT	进展至KDIGO分级3级内的12 h或RRT补救治疗，91%患者行RRT	90 d死亡率	早期组患者死亡率显著改善（39.3% vs 54.7%）	早期组患者肾功能更易恢复，缩短RRT治疗时间及住院时间
AKIKI研究	多中心RCT	KDIGO分级为3级，接受机械通气或血管活性药物治疗	入组后6 h内，所有患者行RRT	少尿超过72 h或RRT补救治疗，51%患者行RRT	60 d死亡率	2组无显著差异（48.5% vs 49.7%）	早期组患者更易罹患RRT相关并发症

研究者	研究设计方案	纳入标准	启动RRT时机		主要结果指标	主要结果
研究者	研究设计方案	纳入标准	早期组	晚期组	主要结果指标	主要结果
ELAIN研究	单中心RCT	KDIGO分级为2级，并且NGAL >150 ng/ml	入组后8 h内，所有患者行RRT	进展至KDIGO分级3级内的12 h或RRT补救治疗，91%患者行RRT	90 d死亡率	早期组患者死亡率显著改善（39.3% vs 54.7%）	早期组患者肾功能更易恢复，缩短RRT治疗时间及住院时间
AKIKI研究	多中心RCT	KDIGO分级为3级，接受机械通气或血管活性药物治疗	入组后6 h内，所有患者行RRT	少尿超过72 h或RRT补救治疗，51%患者行RRT	60 d死亡率	2组无显著差异（48.5% vs 49.7%）	早期组患者更易罹患RRT相关并发症

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