Procon debate Continuous versus intermittent dialysis for acute kidney injury a never-ending story yet approaching the finish 英文参考文献.docVIP

Vanholder et al. Critical Care 2011,15:204 /content/15/1/204 REVIEW Pro/con debate: Continuous versus intermittent dialysis for acute kidney injury: a never-ending story yet approaching the ? nish? Raymond Vanholder *, Wim Van Biesen , Eric Hoste and Norbert Lameire 1 1 2 1 Introduction Abstract Few topics in nephrology have been the subject of so many randomized controlled trials (RCTs), meta-analyses and reviews than that of extracorporeal renal replacement in acute kidney injury (AKI). Since the introduction of hemodialysis as a valid treatment for renal failure by Kol? in the early 1940s [1], intermittent renal replacement therapy (IRRT) was o? ered as a bridge until recovery of kidney function; ? rst in a low-e? cient and therefore protracted version, later becoming progressively shorter. In the 1980s, Kramer and colleagues introduced con tinu- ous renal replacement therapy (CRRT) as an alternative, allowing blood puri? cation 24 hours per day – at least in principle [2]. The question of whether renal replacement therapy should be applied in an intermittent or continuous mode to the patient with acute kidney injury has been the topic of several controlled studies and meta- analyses. Although continuous renal replacement therapy (CRRT) has a theoretical advantage due to o?ering the opportunity to remove excess ?uid more gradually, none of the several outcome studies that have been undertaken in the meanwhile was able to demonstrate its superiority over intermittent renal replacement therapy (IRRT). In the present article, therefore, questions are raised regarding which are the speci?c advantages of each strategy, and which are the speci?c populations that might bene?t from their application. Although several advantages have been attributed to CRRT – especially more hemodyna