成人急性肾损伤患者连续性肾脏替代治疗管理的最佳证据总结

doi:10.3761/j.issn.2096-7446.2024.02.016

摘要/Abstract

摘要： 目的评价并总结对急性肾损伤患者行连续性肾脏替代治疗的最佳证据,为临床实践提供循证依据。方法计算机检索英国国家卫生与临床优化研究所网站、美国国立指南网、美国肾脏病学会、中华医学会肾脏病学分会、Cochrane Library、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、UpToDate、BMJ Best Practice、PubMed、万方数据库、维普网、中国知网等专业协会网站和数据库中关于成人急性肾损伤患者连续性肾脏替代治疗的相关文献。检索时限为建库至2023年2月。结果共纳入15篇文献,包括指南2篇、专家共识5篇、系统评价和Meta分析3篇、证据总结1篇、临床决策4篇,从患者评估、适应证和时机选择、连续性肾脏替代治疗方案、过程监护及并发症预防、营养支持5个方面最终形成了29条最佳证据。结论该研究对成人急性肾损伤连续性肾脏替代治疗的最佳证据进行总结,可为临床实践提供参考,同时也应结合患者状况和我国当前医疗资源来制订个体化的治疗方案,以改善患者的临床结局。

关键词: 急性肾损伤, 连续性肾脏替代治疗, 证据总结, 循证护理学

Abstract: Objective To evaluate and summarize the best evidence for the management of continuous renal replacement therapy in patients with acute kidney injury and to provide evidence for clinical practice. Methods We searched the National Institute for Health and Clinical Excellence website,National Guidelines Network,American Society of Nephrology,Chinese Society of Nephrology,Cochrane Library,Joanna Briggs Institute Evidence-Based Health Care Database,Up To Date,BMJ Best Practice,PubMed,Wanfang,VIP,CNKI,and other professional societies websites and databases for relevant literature on continuous renal replacement therapy in adults with acute kidney injury. The retrieval period was from the establishment of the database to February 2023. Results A total of 15 articles were included,including 2 guidelines,5 expert consensus articles,3 systematic reviews and Meta-analyses,1 evidence summary,and 4 clinical decisions,forming 29 best evidence articles in 5 aspects：patient assessment,indications and timing,continuous renal replacement therapy program,process monitoring and complication prevention,and nutritional support. Conclusion The best evidence for continuous renal replacement therapy in adults with acute kidney injury was summarized in this study,which can provide a reference for clinical practice. The evidence should be combined with patient status and our current medical resources to develop individualized treatment plans to improve clinical outcomes for patients.

Key words: Acute Kidney Injury, Continuous Renal Replacement Therapy, Evidence Summaries, Evidence-Based Nursing

刘嘉龙, 郭文超, 滕娇, 秦寒枝, 金魁, 张振伟, 蒋燕. 成人急性肾损伤患者连续性肾脏替代治疗管理的最佳证据总结[J]. 中华急危重症护理杂志, 2024, 5(2): 172-180.

LIU Jialong, GUO Wenchao, TENG Jiao, QIN Hanzhi, JIN Kui, ZHANG Zhenwei, JIANG Yan. Summary of best evidence for the management of continuous renal replacement therapy in adults with acute kidney injury[J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(2): 172-180.

参考文献

[1] Doi K,Nishida O,Shigematsu T,et al.The Japanese clinical prac-tice guideline for acute kidney injury 2016[J]. Clin Exp Neph-rol,2018,22(5):985-1045.
[2] Matsuura R,Doi K,Rabb H. Acute kidney injury and distant organ dysfunction-network system analysis[J]. Kidney Int,2023,103(6):1041-1055.
[3] Shiao CC,Wu VC,Li WY,et al.Late initiation of renal replacement therapy is associated with worse outcomes in acute kidney injury after major abdominal surgery[J]. Crit Care,2009,13(5):R171.
[4] Schwenger V,Kindgen-Milles D,Willam C,et al.Extracorporeal renal replacement therapy in acute kidney injury:recommendations from the renal section of the DGIIN,GIAIN and DIVI[J]. Med Klin Intensivmed Notfmed,2018,113(5):370-376.
[5] Park S,Lee S,Jo HA,et al.Epidemiology of continuous renal replacement therapy in Korea:results from the National Health Insurance Service claims database from 2005 to 2016[J]. Kidney Res Clin Pract,2018,37(2):119-129.
[6] Kolhe NV,Muirhead AW,Wilkes SR,et al.National trends in acute kidney injury requiring dialysis in England between 1998 and 2013[J]. Kidney Int,2015,88(5):1161-1169.
[7] Claure-Del Granado R,Clark WR. Continuous renal replacement therapy principles[J]. Semin Dial,2021,34(6):398-405.
[8] Zou FQ,Tang XH,Lei XH,et al.Treatment efficacy of continuous renal replacement on symptoms,inflammatory mediators,and coagulation function in patients with sepsis-associated acute kidney injury[J]. Arch Esp Urol,2022,75(9):746-752.
[9] 朱政,胡雁,邢唯杰,等. 不同类型循证问题的构成[J]. 护士进修杂志,2017,32(21):1991-1994.
Zhu Z,Hu Y,Xing WJ,et al.The composition of different types of evidence-based problems[J]. J Nurses Train,2017,32(21):1991-1994.
[10] Dicenso A,Bayley L,Haynes RB.Accessing pre-appraised evidence:fine-tuning the 5S model into a 6S model[J]. Evid Based Nurs,2009,12(4):99-101.
[11] Brouwers MC,Kho ME,Browman GP,et al.AGREE Ⅱ:advancing guideline development,reporting and evaluation in health care[J]. J Clin Epidemiol,2010,63(12):1308-1311.
[12] 胡雁,郝玉芳. 循证护理学[M]. 2版. 北京:人民卫生出版社,2018:2-3.
Hu Y,Hao YF.Evidence-based nursing[M]. 2nd ed. Beijing:People's Medical Publishing House,2018:2-3.
[13] Foster MJ,Shurtz S.Making the Critical Appraisal for Summaries of Evidence(CASE) for evidence-based medicine(EBM):critical appraisal of summaries of evidence[J]. J Med Libr Assoc,2013,101(3):192-198.
[14] 王春青,胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志,2015,30(11):964-967.
Wang CQ,Hu Y.JBI evidence pre-classification and evidence rank system(2014 Edition)[J]. J Nurses Train,2015,30(11):964-967.
[15] Connor MJ,Tolwani AJ. Prescription of continuous kidney repla-cement therapy in acute kidney injury in adults[EB/OL].(2022-06-16)[2023-04-13]. https://www.uptodate.com/contents/prescription-of-continuous-kidney-replacement-therapy-in-acute-kidney-injury-in-adults#!
[16] Palevsky PM. Kidney replacement therapy(dialysis) in acute kidney injury in adults:Indications,timing,and dialysis dose[EB/OL].(2022-11-18)[2023-04-13]. https://www.uptodate.com/contents/kidney-replacement-therapy-dialysis-in-acute-kidney-in-jury-in-adults-indications-timing-and-dialysis-dose.
[17] Davenport A. Anticoagulation for continuous kidney replace-ment therapy[EB/OL].(2022-06-13)[2023-04-13]. https://www.uptodate.com/contents/anticoagulation-for-continuous-kidney-re-pla-cement-therapy.
[18] Golper TA. Continuous kidney replacement therapy in acute kidney injury[EB/OL].(2021-11-23)[2023-04-13]. https://www.uptodate.com/contents/continuous-kidney-replacement-therapy-in-acute-kidney-injury#!
[19] 中华医学会肾脏病学分会专家组. 连续性肾脏替代治疗的抗凝管理指南[J]. 中华肾脏病杂志,2022,38(11)1016-1024.
Expert Group of Nephrology Branch of Chinese Medical Association. Guidelines for the anticoagu-lant management of continuous renal replacement therapy[J]. Chin J Nephrol,2022, 38(11):1016-1024.
[20] Murugan R,Hoste E,Mehta RL,et al.Precision fluid management in continuous renal replacement therapy[J]. Blood Purif,2016,42(3):266-278.
[21] Ostermann M,Joannidis M,Pani A,et al.Patient selection and timing of continuous renal replacement therapy[J]. Blood Purif,2016,42(3):224-237.
[22] 血液净化急诊临床应用专家共识组. 血液净化急诊临床应用专家共识[J]. 中华急诊医学杂志,2017,26(1):24-36.
Expert Consensus Group on Emergency Clinical Application of Blood Purification. Expert consensus on emergency clinical application of blood purification[J]. Chin J Emerg Med,2017, 26(1):24-36.
[23] Annigeri R,Ostermann M,Tolwani A,et al.Renal support for acute kidney injury in the developing world[J]. Kidney Int Rep,2017,2(4):559-578.
[24] Hung KY,Chen ST,Chu YY,et al.Nutrition support for acute kidney injury 2020-consensus of the Taiwan AKI task force[J]. J Chin Med Assoc,2022,85(2):252-258.
[25] Douvris A,Malhi G,Hiremath S,et al.Interventions to prevent hemodynamic instability during renal replacement therapy in critically ill patients:a systematic review[J]. Crit Care,2018,22(1):41.
[26] Zhang W,Bai M,Yu Y,et al.Continuous renal replacement therapy without anticoagulation in critically ill patients at high risk of bleeding:a systematic review and meta-analysis[J]. Semin Dial,2021,34(3):196-208.
[27] Chen JJ,Lee CC,Kuo G,et al.Comparison between watchful waiting strategy and early initiation of renal replacement therapy in the critically ill acute kidney injury population:an updated systematic review and meta-analysis[J]. Ann Intensive Care,2020,10(1):30.
[28] Valdenebro M,Martín-Rodríguez L,Tarragón B,et al.Renal replacement therapy in critically ill patients with acute kidney injury:2020 nephrologist's perspective[J]. Nefrologia(Engl Ed),2021,41(2):102-114.
[29] Zarbock A,Kellum JA,Schmidt C,et al.Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury:the ELAIN randomized clinical trial[J]. JAMA,2016,315(20):2190-2199.
[30] Kellum JA,Lameire N,Aspelin P,et al.Kidney disease:improving global outcomes(KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury[J]. Kidney Int Suppl,2012,2(1):1-138.
[31] RENAL Replacement Therapy Study Investigators,Bellomo R,Cass A,et al. Intensity of continuous renal-replacement therapy in critically ill patients[J]. N Engl J Med,2009,361(17):1627-1638.
[32] Wiesen P,Van Overmeire L,Delanaye P,et al.Nutrition disorders during acute renal failure and renal replacement therapy[J]. J Parenter Enteral Nutr,2011,35(2):217-222.
[33] Sabatino A,Theilla M,Hellerman M,et al.Energy and protein in critically ill patients with AKI:a prospective,multicenter observational study using indirect calorimetry and protein catabolic rate[J]. Nutrients,2017,9(8):802.