week in this setting on the basis that no clinical benefits have been demonstrated with more frequent hemodialysis. This should not detract from the importance of continually assessing and refining the hemodialysis prescription (including the need for extra treatments) according to dynamic changes in extracellular volume and other parameters, and ensuring that an adequate dose of hemodialysis is being delivered to the patient. Compared with other KRT modalities, the cardinal challenge encountered during intermittent hemodialysis is hemodynamic instability. This phenomenon occurs when reductions in intravascular volume, as a consequence of ultrafiltration and/or osmotic shifts, outpace compensatory plasma refilling from the extravascular space. Myocardial stunning, triggered by intermittent hemodialysis, and independent of ultrafiltration, may also contribute. The hemodynamic effect of intermittent hemodialysis is likely magnified in patients who are critically ill due to an inability to mount sufficient compensatory physiologic responses in the context of multiorgan dysfunction. Of the many interventions that have undergone testing to mitigate hemodynamic instability related to KRT, the best evidence exists for cooling the dialysate and raising the dialysate sodium concentration. Unfortunately, the evidence supporting routine use of these and other interventions is weak owing to poor study quality and limited sample sizes. Intermittent hemodialysis will continue to be an important and commonly used KRT modality for AKI in patients with critical illness, especially in jurisdictions where resources are limited. There is an urgent need to harmonize the definition of hemodynamic instability related to KRT in clinical trials and robustly test strategies to combat it in this vulnerable patient population....

中文翻译：

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危重病人间歇性血液透析的管理


在这种情况下一周的基础上，没有证明更频繁的血液透析有任何临床益处。这不应减损根据细胞外容量和其他参数的动态变化不断评估和完善血液透析处方（包括额外治疗的需要）并确保向患者提供足够剂量的血液透析的重要性。与其他 KRT 方式相比，间歇性血液透析期间遇到的主要挑战是血流动力学不稳定。当超滤和/或渗透压变化导致血管内容量减少超过血管外空间补偿性血浆再填充时，就会发生这种现象。由间歇性血液透析引发且与超滤无关的心肌顿抑也可能有所贡献。由于在多器官功能障碍的情况下无法产生足够的代偿性生理反应，间歇性血液透析的血流动力学效应可能会在危重患者中放大。在经过测试以减轻与 KRT 相关的血流动力学不稳定的许多干预措施中，最好的证据是冷却透析液和提高透析液钠浓度。不幸的是，由于研究质量差和样本量有限，支持常规使用这些干预措施和其他干预措施的证据很薄弱。间歇性血液透析将继续成为危重疾病患者 AKI 的重要且常用的 KRT 方式，特别是在资源有限的司法管辖区。 迫切需要在临床试验中协调与 KRT 相关的血流动力学不稳定的定义，并强有力地测试策略以在这一脆弱的患者群体中对抗它......