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Báo cáo y học: "Dose of dialysis in the intensive care unit: is the venom in the dose or in the clinical experience"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Dose of dialysis in the intensive care unit: is the venom in the dose or in the clinical experience? | Available online http ccforum.eom content 13 3 155 Commentary Dose of dialysis in the intensive care unit is the venom in the dose or in the clinical experience Norbert Lameire Wim Van Biesen and Raymond Vanholder Renal Division University Hospital De Pintelaan 185 9000 Gent Belgium Corresponding author Norbert Lameire norbert.lameire@ugent.be Published 10 June 2009 This article is online at http ecforum.eom eontent 13 3 155 2009 BioMed Central Ltd Critical Care 2009 13 155 doi 10.1186 cc7873 See related research by Vesconi et al. http ccforum.com content 13 2 R57 Abstract Many studies on the most adequate dose of renal replacement therapy RRT in critically ill patients with acute kidney injury have obtained contradictory results. The previous issue of Critical Care reports a multi-centre study showing that a higher than conventional dose of RRT whether continuous RRT or intermittent RRT is not associated with better survival of these patients. This commentary highlights some of the problems associated with the interpretation of this and previously published studies. These problems include the use of targets of Kt V urea or the ultrafiltration rate in millilitres per kilogram body weight the latter quite difficult to estimate in these patients the divergent co-morbidities of the patients and the local experience of intensivists or nephrologists with either continuous RRT or intermittent RRT. The last factor could explain why some single centre studies did find an impact of dialysis dose on the survival of these patients whereas multi-centre studies did not. In the previous issue of Critical Care an article by Vesconi and colleagues 1 describes the impact of the dose of renal replacement therapy RRT on clinical outcomes in critically ill patients with acute kidney injury. This study was performed in a number of European intensive care units ICUs . Dialysis dose was defined as more intensive continuous RRT CRRT 35 ml kg h intermittent RRT IRRT 6 sessions week or less