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Terapia de reemplazo renal en pacientes con insuficiencia renal aguda: una revisión sistemática
Neesh Pannu1, Scott Klarenbach, Natasha Wiebe
1Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
JAMA
|February 21, 2008
Resumen
La diálisis de insuficiencia renal aguda muestra resultados similares para la terapia de reemplazo renal continua (TRRC) y la hemodiálisis intermitente. Las dosis más altas de CVVHF pueden reducir la mortalidad, pero se necesita más investigación para un manejo óptimo de la insuficiencia renal aguda.
Área de la Ciencia:
- Nefrología Nefrología.
- Medicina de cuidados críticos Medicina de cuidados críticos.
- Terapia de reemplazo renal con terapia de reemplazo renal.
Sus antecedentes:
- La insuficiencia renal aguda (IRA) que requiere diálisis está relacionada con una alta mortalidad y morbilidad.
- El apoyo dialítico es crucial para el manejo de los pacientes con FRA.
Objetivo del estudio:
- Para sintetizar la evidencia sobre la provisión de diálisis para ARF.
- Ofrecer recomendaciones de gestión.
- Identificar las lagunas de investigación en el tratamiento de la FRA.
Principales métodos:
- Búsqueda sistemática de la bibliografía (MEDLINE, EMBASE, EBM Reviews) hasta octubre de 2007 (en inglés).
- Se incluyeron ECA y estudios de cohorte prospectivos en pacientes adultos con FRA.
- Evaluación de la calidad utilizando el puntaje Jadad y la lista de verificación Downs and Black.
Principales resultados:
- Comparó CRRT y hemodiálisis intermitente, sin encontrar diferencias significativas en la mortalidad o la necesidad de diálisis crónica.
- Sugerencia de diálisis de bicarbonato y anticoagulación de citrato para CRRT.
- Las dosis más altas de CVVHF indicadas (35 ml / kg / h) pueden reducir la mortalidad.
- No se recomienda usar membranas celulósicas no sustituidas en la hemodiálisis intermitente.
Conclusiones:
- La hemodiálisis intermitente y la CRRT ofrecen resultados clínicos comparables en la FRA.
- La dosis recomendada de CVVHF es de 35 ml/kg/hora.
- Destacó la necesidad de más ECA de alta calidad para guiar la gestión de ARF.
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