Читать книгу 40 Years of Continuous Renal Replacement Therapy - Группа авторов - Страница 42

Recent temporal trends show increasing utilization of renal replacement therapy (RRT) in critically ill patients in intensive care unit (ICU) settings [1]. Continuous RRT (CRRT), a core life-support technology unique to the ICU, remains the most common form of renal support provided to critically ill patients.

The dilemma of when to ideally start CRRT in critically ill patients, specifically in those with acute kidney injury (AKI) or in those confronted with grossly impaired kidney function and multiorgan dysfunction, has been a longstanding challenge for intensivists and nephrologists. The decision to start RRT is often relatively straightforward in patients with medically refractory complications associated with AKI (i.e., hyperkalemia, acidemia, pulmonary edema, uremia); however, these complications are increasingly infrequent among critically ill patients [2]. In the absence of clearly urgent indications, the optimal time for starting CRRT remains uncertain. In these circumstances, the utilization of CRRT is driven largely by the perception of clinicians in terms of greater relative benefit than risk and often started in response to trends in illness acuity, non-renal organ dysfunction (i.e., acute lung injury) and kidney function recovery [3]. This issue, when to ideally start RRT in critically ill patients with AKI, has been identified as high priority for new knowledge in critical care and nephrology [4].