Читать книгу 40 Years of Continuous Renal Replacement Therapy - Группа авторов - Страница 49

The optimal time to start RRT in critically ill patients with AKI remains a vexing clinical dilemma for nephrology and critical care clinicians. Available evidence has highlighted the challenges and complexity of protocolizing the timing of RRT initiation strategies. In the absence of a reliable clinical tool to predict which patients will worsen and are likely to receive RRT, a patient-centered “personalized” approach that encompasses careful consideration of the overall trajectory, integrating baseline clinical information, illness acuity, burden of organ dysfunction, along with trends in physiological and laboratory data, rather than relying on absolute or arbitrary threshold laboratory values, is needed. Recent data have implied that a strategy of watchful waiting in carefully selected patients may be reasonable. Additional data from ongoing trials will hopefully further inform best clinical practice and provide direction to both reduce unnecessary practice variation and improve patient outcomes.