Contemporary Management of Severe Acute Kidney Injury and Refractory Cardiorenal Syndrome: JACC Council Perspectives.
Jentzer Jacob C, Bihorac Azra, Brusca Samuel B, Del Rio-Pertuz Gaspar, Kashani Kianoush, Kazory Amir, Kellum John A, Mao Michael, Moriyama Brad, Morrow David A, Patel Hena N, Rali Aniket S, van Diepen Sean, Solomon Michael A, Critical Care Cardiology Working Group of the Heart Failure and Transplant Section Leadership Council
Journal of the American College of Cardiology · 2020 · PMID 32854844 · 인용 140
Acute kidney injury (AKI) and cardiorenal syndrome (CRS) are increasingly prevalent in hospitalized patients with cardiovascular disease and remain associated with poor short- and long-term outcomes. There are no specific therapies to reduce mortality related to either AKI or CRS, apart from supportive care and volume status management. Acute renal replacement therapies (RRTs), including ultrafiltration, intermittent hemodialysis, and continuous RRT are used to manage complications of medically refractory AKI and CRS and may restore normal electrolyte, acid-base, and fluid balance before renal recovery.
Patients who require acute RRT have a significant risk of mortality and long-term dialysis dependence, emphasizing the importance of appropriate patient selection. Despite the growing use of RRT in the cardiac intensive care unit, there are few resources for the cardiovascular specialist that integrate the epidemiology, diagnostic workup, and medical management of AKI and CRS with an overview of indications, multidisciplinary team management, and transition off of RRT.