急性肾损伤患者肾替代治疗时机:宜早宜晚?

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

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.