Fluid overload in AKI: epiphenomenon or putative effect on mortality?
Fluid overload in AKI: epiphenomenon or putative effect on mortality?
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DOI：
10.1097/mcc.0b013e32835a1c44
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发表时间：
2012-12
影响因子：
3.3
通讯作者：
Liu KD
中科院分区：
文献类型：
--
作者：
Butcher BW;Liu KD
急性肾损伤（阿基）的发病率正在急剧增加，尽管透析治疗和重症监护取得了进展，但相关发病率和死亡率几乎没有改善。最近，几篇文章表明，阿基患者的液体超负荷与死亡风险增加有关。观察性研究已经证明了阿基患者中液体超负荷与不良结局（包括死亡）之间的相关性;然而，这种相关性是因果关系还是由于残留混杂因素所致尚不清楚。最近一项在随机对照试验背景下测试液体过载和利尿剂对结局的影响的研究表明，利尿剂对阿基患者的有益影响是通过减少液体过载来介导的。最后，体液超负荷可能导致死亡的潜在机制包括由于肌酐稀释而无法识别阿基，直接组织水肿导致肾灌注减少，以及其他并发症（如败血症）风险增加。根据目前的文献，液体超负荷的直接影响与液体超负荷与其他患者特征（例如，脓毒症）仍然未知。其他的人体研究，包括随机对照试验，有必要进一步澄清这些问题。
The incidence of acute kidney injury (AKI) is increasing dramatically, and despite advances in dialytic therapy and critical care, there has been little improvement in associated morbidity and mortality. Recently, several articles have suggested that fluid overload in patients with AKI is associated with an increased risk of death. Observational studies have demonstrated an association between fluid overload and poor outcomes (including death) in patients with AKI; however, whether this association is causal or due to residual confounding is unknown. A recent study testing the impact of fluid overload and diuretics on outcomes in the context of a randomized controlled trial suggests that the beneficial impact of diuretics in those with AKI is mediated by reducing fluid overload. Finally, potential mechanisms by which fluid overload may contribute to death include failure to recognize AKI due to creatinine dilution, direct tissue edema leading to decreased renal perfusion, and an increased risk of other complications such as sepsis. Based on the current literature, the relative contributions of the direct effects of fluid overload versus the association of fluid overload with other patient characteristics associated with adverse outcome (e.g., sepsis) remain unknown. Additional human studies, including randomized controlled trials, are warranted to further clarify these issues.