持续性肾脏替代治疗在急性肾损伤中的应用

急性肾损伤(Acute kidney injury,AKI)是一种涉及多学科的临床常见危重病症,发病率逐年上升,死亡率高.持续性肾脏替代治疗(replacement therapy,RRT)是一种连续、缓慢清除水分和溶质,对脏器起支持作用的血液净化技术.现有证据显示早期RRT介入和AKI患者预后改善相关.高剂量治疗[35 ml/(kg·h)]不能使肾脏替代治疗获益,目前的推荐剂量是20～25 ml/(kg·h).鉴于AKI病因的多样性,患者年龄、性别、血流动力学等的不同及荟萃分析本身的局限性,仍需进行大规模的RCT,针对不同的AKI原因进行分层随机研究,以进一步确定CRRT治疗的时机、方式、剂量等.

Application of CRRT in acute kidney injury

Acute kidney injury（AKI） is a multi-disciplinary common clinical critical disease.The incidence rate increases every year with high mortality.Continuous renal replacement therapy（RRT） is a blood purification technology which continuously and slowly clears water and solute,and supports organs.Available evidence indicates that early RRT intervention improved the prognosis of patients with AKI.High-dose therapy [35 ml/（kg·h）] can not benefit RRT and the current recommended dose is 20～25 ml/（kg·h）.Given the diversity of the causes of AKI,age,gender,and blood flow dynamics,and the limitations of meta-analysis,we still need large-scale and stratified randomized controlled trials to further determine the timing,method and dosage of CRRT.