急性肾脏损伤在重症患者中很常见，其中许多人接受肾脏替代治疗，但其最有效时机仍不确定。
研究组进行了一项多国、随机、对照试验，招募了2927例重症急性肾损伤的患者，将其随机分组，其中1465例接受加速肾脏替代治疗策略，在12小时内开始治疗；1462例接受标准策略，不鼓励使用肾脏替代疗法，除非出现常规适应症或急性肾损伤持续超过72小时。主要结局为90天内的全因死亡。
加速策略组中有1418例（968％）接受了肾脏替代治疗，而标准策略组有903例（618％）。在第90天时，加速策略组中死亡643例（439％），标准策略组中死亡639例（437％），无显著差异。加速策略组中814例90天后仍存活的患者中有85例（104％）对肾脏替代疗法持续依赖，标准策略组中815例中有49例（60％），相对风险为174。加速策略组中不良事件的发生率为230％，显著高于标准策略组（165％）。
总之，对于患有急性肾损伤的重症患者，加速肾脏替代治疗并不能降低90天的死亡风险。
附：英文原文
title: timing of initiation of renal-replacement therapy in acute kidney injury
author: the starrt-aki investigators
issuevolume: 2020-07-15
abstract: abstract
background
acute kidney injury is common in critically ill patients, many of whom receive renal-replacement therapy however, the most effective timing for the initiation of such therapy remains uncertain
methods
we conducted a multinational, randomized, controlled trial involving critically ill patients with severe acute kidney injury patients were randomly assigned to receive an accelerated strategy of renal-replacement therapy (in which therapy was initiated within 12 hours after the patient had met eligibility criteria) or a standard strategy (in which renal-replacement therapy was discouraged unless conventional indications developed or acute kidney injury persisted for >72 hours) the primary outcome was death from any cause at 90 days
results
of the 3019 patients who had undergone randomization, 2927 (970%) were included in the modified intention-to-treat analysis (1465 in the accelerated-strategy group and 1462 in the standard-strategy group) of these patients, renal-replacement therapy was performed in 1418 (968%) in the accelerated-strategy group and in 903 (618%) in the standard-strategy group at 90 days, death had occurred in 643 patients (439%) in the accelerated-strategy group and in 639 (437%) in the standard-strategy group (relative risk, 100; 95% confidence interval [ci], 093 to 109; p=092) among survivors at 90 days, continued dependence on renal-replacement therapy was confirmed in 85 of 814 patients (104%) in the accelerated-strategy group and in 49 of 815 patients (60%) in the standard-strategy group (relative risk, 174; 95% ci, 124 to 243) adverse events occurred in 346 of 1503 patients (230%) in the accelerated-strategy group and in 245 of 1489 patients (165%) in the standard-strategy group (p<0001)
conclusions
among critically ill patients with acute kidney injury, an accelerated renal-replacement strategy was not associated with a lower risk of death at 90 days than a standard strategy
doi: 101056nejmoa2000741
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