Yoğun bakımdaki kritik hastalarda akut böbrek hasarında renal replasman tedavisi kararı ve zamanlaması

Yoğun bakım ünitelerinde (YBÜ) takip edilen kritik hastalarda gelişen akut böbrek hasarı (ABH) önemli bir morbidite ve mortalite nedenidir. Bu hastalarda yapılan renal replasman tedavilerinin (RRT) başlatılmasında hangi kriterlerin kullanılacağı ve tedavinin ne zaman başlatılacağı soruları net olarak cevaplanmış değildir. Bu derlemede YBÜ’de RRT başlangıcını belirleyen faktörler incelendi. Ayrıca hastaların üre-kreatinin seviyeleri, idrar çıkışı-sıvı yükü, YBÜ yatışı ile RRT başlangıcı arasında geçen süre, prognostik faktörler ve bazı belirteçlere göre başlatılan erken ve geç RRT çalışmaları incelendi. Sonuçta YBÜ’de kritik hastalarda RRT başlangıcını belirleyen kriterler ve bu kriterlerin eşik değerlerinin kişiselleştirilmesi gerektiği düşünüldü.

Acute kidney injury (AKI) developing in intensive care units (ICU) is an important cause of morbidity and mortality. The answers to the questions of which criteria are to be used in the initiation of and when to start renal replacement therapies (RRT) in those patients are not clear yet. In this review, urea and creatinine levels, urinary output and fluid load, duration between ICU admission and initiation of RRT, prognostic scores, and some RRT studies that were started early or late according to some markers were evaluated. In conclusion, the criteria to be used in the initiation of RRT in ICUs and the threshold levels of those criteria should be individualized.

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