Читать книгу 40 Years of Continuous Renal Replacement Therapy - Группа авторов - Страница 45

CRRT can be associated with complications. CRRT necessitates central venous dialysis catheter insertion, exposure of blood to an extracorporeal circuit, and often use continuous anticoagulation to maintain circuit patency. CRRT, largely driven by ultrafiltration rate, has the potential to incite hemodynamic instability and contribute to delayed kidney recovery. CRRT also adds workload for bedside personnel, increases resource use, and is costly. As such, in the absence of high-quality data from rigorous clinical trials, there is a compelling argument for adopting a conservative approach for when to start CRRT. A number of clinical trials have not shown earlier that CRRT improves patients-centered outcomes when started in the absence of conventional indications or in response to AKI complications [7, 10, 11]. Accordingly, the theoretical and patient-specific benefit for earlier CRRT must be counterbalanced with the incremental resource implications and potential risk for delayed recovery or other complications related to CRRT (Table 2).

Table 2. Benefits and drawbacks of earlier RRT in the absence of conventional indications among critically ill patients with AKI (adapted from [22])