延长的间歇性肾脏替代治疗

Prolonged intermittent renal replacement therapy

肾脏替代治疗自上世纪起发展至今,已经取得长足的进步,并得到广泛的应用,尤其是在急性肾损伤方面。其主要模式包括间歇性血液透析(intermittent hemodialysis, IHD)、连续性肾脏替代治疗(continuous renal replacement therapy, CRRT)、腹膜透析等,各有其优缺点,延长的间歇性肾脏替代治疗(prolonged intermittent renal replacement therapy, PIRRT)应运而生。作为一种杂合的肾脏替代治疗,PIRRT结合了IHD的经济性和CRRT的血流动力学稳定性,在提供与其剂量相当的肾脏替代同时,节省人力物力,并能提供治疗间歇以进行其他诊治,已成为国内外的研究热点。但由于缺乏明确的指南,PIRRT在临床的应用仍面临着严峻的挑战,尤其是在透析剂量和药物剂量方面。未来应当有更多的临床证据来给予PIRRT统一的标准。

Renal replacement therapy（RRT） has made great progresses since the last century. RRT is now widely used, especially for acute kidney injury. The main modalities of RRT consist of intermittent hemodialysis（IHD）, continuous renal replacement therapy（CRRT）, peritoneal dialysis（PD）, etc. Each of these modalities has its own advantages and disadvantages. The prolonged intermittent renal replacement therapy（PIRRT） emerges in order to improve the efficiency of RRT. As a hybrid RRT, PIRRT combing the efficiency of IHD and the stable hemodynamics of CRRT is able to clear small solutes with an efficacy comparable to IHD and CRRT, and offers the advantages of flexible time for treatment and reduced medical expenses. Consequently, PIRRT has become one of the hotspots in China and other countries. However, due to the lack of clear guidelines, PIRRT is still faced with significant challenges, especially pertaining to appropriate dialysate volume and drug doses. There should be more clinical trials to develop a unified standard for PIRRT in the future.