334 Ch 333. AKI Management and Renal Replacement Therapy

AKI management 三大支柱：(1) address underlying cause (volume resuscitation, hold nephrotoxins, treat sepsis, decompress obstruction, treat GN/AIN)；(2) supportive care (fluid + electrolyte + acid-base + nutrition)；(3) renal replacement therapy (RRT) when indicated；RRT indications：AEIOU = Acidosis refractory、Electrolyte (hyperkalemia refractory)、Ingestion (toxin removable)、Overload (volume refractory)、Uremia (encephalopathy, pericarditis, bleeding)；modalities：(1) IHD (intermittent hemodialysis) — ICU stable patient or non-ICU；(2) CRRT (continuous renal replacement therapy) — CVVH, CVVHD, CVVHDF — for hemodynamically unstable；(3) SLED (sustained low-efficiency dialysis) — hybrid；(4) PD (peritoneal dialysis) — less common AKI；AKIKI, STARRT-AKI, IDEAL-ICU trials：no benefit to earlier-than-need-based dialysis initiation；recovery：AKI accelerates CKD progression — surveillance critical post-AKI；2024 MOIRA, anti-hepcidin + erythropoietin alternatives + AI risk prediction emerging。