危重症急性肾损伤患者启动肾脏替代治疗的时机

Timing of initiating renal replacement therapy in critical patients with acute kidney injury

急性肾损伤是急危重症的常见并发症,可显著增加死亡率。对于内环境不稳定并且具有急诊透析指征的患者,启动肾脏替代治疗是抢救的重要措施。但是,病情严重程度未达到急诊透析指征时,启动肾脏替代治疗的合适时机尚无定论。尽管一些前期研究进行了初步探索,但这些研究或为观察性设计,样本量较小,或存在选择性偏倚。目前循证医学证据不支持早期进行肾脏替代治疗有明确的获益。启动肾脏替代治疗需参考多个临床指标。

Acute renal injury is a common complication of critically illness,which can significantly increase the mortality.Renal replacement therapy is an important measure to cure the patients with internal environment disturbance and indication of emergency dialysis,but without the indication of emergency dialysis,the optimal timing of initiating renal replacement therapy for acute renal injury remains uncertain.Although some previous studies have made preliminary exploration,they are either observational design,small sample size or selective bias.The evidence of existing evidencebased evidence does not support the specific benefit of early renal replacement therapy.We should consider multiple clinical indicators when making the decision to start renal replacement therapy.