dCRRT and AKI课件.ppt

In this study , No added benefit from an intensive (highdose) treatment strategy as compared with the more conventional. Hypotension occurred at a similar rate during intermittent-hemodialysis sessions in the two groups. Hypophosphatemia and hypokalemia were more frequent complications in the intensive-therapy group. Single-center trials that showed improved survival with more-intensive renal-replacement therapy in patients with acute kidney injury. Schiffl H, Lang SM, Fischer R. Daily hemodialysis and the outcome of acute renal failure. N Engl J Med 2002 ; 346:305- 10. Reduction in 28-day mortality from 46% with alternate-day dialysis to 28% with daily dialysis. The delivered dialysis dose per session was substantially lower than that used in the present study. Ronco et al. Reduction in mortality from 59% to 43% when ultrafiltration was increased from 20 to 35 ml /kg/hr during CVVH but observed no further benefit with an increase to 45 ml/Kg/hr. Ronco C, Bellomo R, Homel P, et al.Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet 2000;356:26-30. Saudan et al. Reduction in mortality from 61% to 41% with the addition of dialysate at a dose of 18 ml /Kg/hr to CVVH at an ultrafiltration rate of approximately 25 ml /Kg/hr Saudan P, Niederberger M, De Seigneux S, et al. Adding a dialysis dose to continuous hemofiltration increases survival in patients with acute renal failure. Kidney Int 2006;70:1312-7. In contrast, our results are similar to those reported by Bouman et al., No improvement in survival with early high-volume CVVH (48 ml /Kg/Hr) as compared with either early or late low-volume continuous venovenous hemofiltration (19 to 20 ml /Kg/hr). Bouman CS, Oudemans-Van Straaten HM, Tijssen JG, Zandstra DF, Kesecioglu J. Effects of early high-volume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care p