Continuous renal replacement therapy in the treatment of acute renal failure: Critical assessment is required
Continuous renal replacement therapy in the treatment of acute renal failure: Critical assessment is required
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DOI：
10.2215/cjn.02890806
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发表时间：
2007-03-01
影响因子：
9.8
通讯作者：
Himmelfarb, Jonathan
中科院分区：
文献类型：
--
作者：
Himmelfarb, Jonathan
1977年，针对危重患者的连续性肾脏替代治疗（CRRT）被引入，并几乎立即被誉为间歇性血液透析（IHD）的改进替代方案。CRRT已经在临床实践中应用了30年，我们可以公平地问，与IHD相比，基于研究的证据（而不是专家意见）是否支持使用这种复杂的技术。几项随机临床试验比较了CRRT和IHD的结局。在一项试验中，分配接受CRRT的患者的重症监护死亡率显著较高。在最近的其他试验中，结果没有显著差异。观察性研究的荟萃分析同样显示CRRT与IHD相比没有获益，最近的趋势实际上有利于IHD。虽然相当多的注意力集中在CRRT与IHD相比的感知获益上，但相对较少的注意力集中在风险增加的潜力上。在检查近期观察性研究和临床试验的全部证据时，没有令人信服的证据支持CRRT在治疗ARF危重患者方面优于IHD。
A continuous approach to renal replacement therapy (CRRT) for critically ill patients was introduced in 1977 and was hailed almost immediately as an improved alternative to intermittent hemodialysis (IHD). Now that CRRT has been in clinical practice for three decades, it is fair to ask whether research-based evidence (rather than expert opinion) supports the use of this complex technology in comparison to IHD. Several randomized clinical trials have compared the outcomes of CRRT and IHD. In one trial, patients assigned to CRRT had a significantly higher intensive-care mortality rate. In other recent trials, there has been no significant difference in outcome. A meta-analysis of observational studies similarly shows no benefit of CRRT versus IHD, with recent trends actually favoring IHD. While considerable attention has been focused on perceived benefits of CRRT compared to IHD, comparatively less attention has been focused on the potential for increased risks. When examining the totality of evidence from recent observational studies and clinical trials, there is no convincing evidence to support superiority of CRRT over IHD in the treatment of critically ill patients with ARF.