Báo cáo y học: Clinical review: Timing and dose of continuous renal replacement therapy in acute kidney injury

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Báo cáo y học: " Clinical review: Timing and dose of continuous renal replacement therapy in acute kidney injury" Available online http://ccforum.com/content/11/6/232ReviewClinical review: Timing and dose of continuous renalreplacement therapy in acute kidney injuryPaul M PalevskyRenal Section, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, and Renal-Electrolyte Division, Department of Medicine, University ofPittsburgh School of Medicine, Pittsburgh, PA 15261, USACorresponding author: Paul M Palevsky, palevsky@pitt.eduPublished: 6 November 2007 Critical Care 2007, 11:232 (doi:10.1186/cc6121)This article is online at http://ccforum.com/content/11/6/232© 2007 BioMed Central Ltd.Abstract outcomes of AKI and that optimization of renal support may reduce its high mortality [6-8]. Recent studies haveThe optimal management of renal replacement therapy (RRT) in suggested that more intensive dosing of both continuousacute kidney injury (AKI) remains uncertain. Although it is well [9,10] and intermittent [11] RRT are associated withaccepted that initiation of RRT in patients with progressiveazotemia prior to the development of overt uremic manifestations is reductions in mortality; however, results have not beenassociated with improved survival, whether there is benefit to even consistent across all studies [12] and these findings have notearlier initiation of therapy is uncertain. Although retrospective and been widely applied in clinical practice [13]. Although thisobservational studies have suggested improved survival with very review focuses on the issue of timing and dose of continuousearly initiation of continuous RRT (CRRT), interpretation of these RRT (CRRT), summarizing recent data and suggestingstudies is confounded by their failure to include patients with AKI avenues for future research, it should be recognized thatwho recover renal function or die without ever receiving RRT.Several studies have suggested that more intensive delivery of many of the same issues apply to the management ofCRRT during AKI is associated with improved survival, although intermittent hemodialysis in AKI. The related issue of modalityresults of trials have been inconsistent. Two large multicenter of renal support, the subject of multiple recent studiesrandomized clinical trials addressing this question are currently [14-17], is beyond the scope of this review, and has beenunderway and should provide more definitive data within the next reviewed and debated elsewhere [18-22].two years. Timing of initiation of continuous renalIntroduction replacement therapyThe optimal management of renal replacement therapy (RRT) Although the focus of this review is on CRRT, a briefin acute kidney injury (AKI) is uncertain. Although supportive summary of data regarding the initiation of intermittent hemo-care with RRT has been the mainstay of treatment of severe dialysis in AKI is informative. The concept of prophylacticAKI for more than five decades, many fundamental aspects of hemodialysis in AKI was introduced by Teschan andRRT management remain controversial, including selection of colleagues more than 50 years ago [23,24]. A series of retro-modality, timing of initiation, and dosing of therapy. In the spective case series and observational studies conductedpast, the commonly held view was that patients with from the 1950s through the early 1970s compared ‘early’advanced renal dysfunction died with, but, so long as acute initiation of hemodialysis, as defined by blood urea nitrogenuremic complications were prevented, did not die of, their (BUN) concentrations ranging from & ...