UAB CRRT学会论文集(2023-2024):管理急性RRT的降级和优化RRT过渡期间的药物剂量。

IF 3 Q1 UROLOGY & NEPHROLOGY
Kidney360 Pub Date : 2025-08-08 DOI:10.34067/KID.0000000951
William Beaubien-Souligny, Melissa Thompson Bastin, J Pedro Teixeira, Jorge Cerda, Michael J Connor, Amanda Dijanic Zeidman, Pranav S Garimella, Luis Juncos, Arnaldo Lopez-Ruiz, Ravindra Mehta, Thiago Reis, Lilia Rizo-Topete, Samuel A Silver, J Ricardo Da Silva, Rajesh Speer, Anitha Vijayan, Catherine Wells, Keith Wille, Lenar Yessayan, Ashita Tolwani, Javier A Neyra
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引用次数: 0

摘要

在阿拉巴马大学伯明翰分校持续肾脏替代治疗(CRRT)学院的第二期会议中,我们重点关注急性肾替代治疗的护理转变。虽然我们已经收集了数千名急性肾损伤(AKI)危重患者随机分配到不同的RRT启动策略的数据,但没有试验数据可以指导在重症监护室降低RRT的升级。然而,对于肾功能恢复不够快,无法直接从CRRT中解脱出来的严重AKI幸存者,成功的降格治疗需要从CRRT过渡到间歇性RRT模式。这些过渡时期必须小心把握,因为它们可能是并发症的来源,如过渡失败或透析内低血压,这反过来又与死亡风险增加和肾脏恢复几率降低有关。在这篇综述中,我们将重点关注在RRT治疗降压过程中需要考虑的关键因素,重点是模式转变,容量状况在指导RRT降压方法中的作用,以及在这一过渡时期谨慎给药的重要性,特别是抗菌药物。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Proceedings of the UAB CRRT Academy (2023-2024): Managing De-Escalation of Acute RRT and Optimizing Drug Dosing During RRT Transitions.

In this second installment of the proceedings of the University of Alabama at Birmingham Continuous Renal Replacement Therapy (CRRT) Academy, we focus on the topic of transitions of care in acute RRT. Though we have accumulated data from thousands of critically ill patients with acute kidney injury (AKI) randomized to different strategies for RRT initiation, no trial data exist to guide de-escalation of RRT in the intensive care unit. However, for survivors of severe AKI whose kidney function does not recovery rapidly enough to allow for liberation directly from CRRT, successful de-escalation of care requires the transition from CRRT to intermittent RRT modalities. These transition periods must be carefully navigated since they can be a source of complications, such as failure to transition or intra-dialytic hypotension, which are in turn associated with an increased risk of mortality and reduced odds of kidney recovery. In this review, we focus on the critical factors to consider during de-escalation of RRT care, with a focus on modality transition, the role of volume status in guiding the approach to de-escalation of RRT, and the vital importance of careful dosing of drugs, especially antimicrobial agents, during this transitional period.

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来源期刊
Kidney360
Kidney360 UROLOGY & NEPHROLOGY-
CiteScore
3.90
自引率
0.00%
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