Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009;13(6):317.
doi: 10.1186/cc8037. Epub 2009 Nov 11.

A proposed algorithm for initiation of renal replacement therapy in adult critically ill patients

Sean M Bagshaw  1 , Dinna N Cruz, R T Noel Gibney, Claudio Ronco
Affiliations

A proposed algorithm for initiation of renal replacement therapy in adult critically ill patients

Sean M Bagshaw et al. Crit Care. 2009.

Abstract

Critically ill patients whose course is complicated by acute kidney injury often receive renal replacement therapy (RRT). For these patients, initiation of RRT results in a considerable escalation in both the complexity and associated cost of care. While RRT is extensively used in clinical practice, there remains uncertainty about the ideal circumstances of when to initiate RRT and for what indications. The process of deciding when to initiate RRT in critically ill patients is complex and is influenced by numerous factors, including patient-specific and clinician-specific factors and those related to local organizational/logistical issues. Studies have shown marked variation between clinicians, and across institutions and countries. As a consequence, analysis of ideal circumstances under which to initiate RRT is challenging. Recognizing this limitation, we review the available data and propose a clinical algorithm to aid in the decision for RRT initiation in critically ill adult patients. The algorithm incorporates several patient-specific factors, based on evidence when available, that may decisively influence when to initiate RRT. The objective of this algorithm is to provide a starting point to guide clinicians on when to initiate RRT in critically ill adult patients. In addition, the proposed algorithm is intended to provide a foundation for prospective evaluation and the development of a broad consensus on when to initiate RRT in critically ill patients.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Algorithm for initiation of renal replacement therapy in critically ill patients. *'Optimized resuscitation' of the kidney should also include discontinuation/withholding nephrotoxic medications and anti-hypertensive medications that may exacerbate kidney function. §Exogenous toxins (see [56]) and selected endogenous toxins (for example, myoglobin; see text). AKI, acute kidney injury; AKIN, Acute Kidney Injury Network; RRT, renal replacement therapy.
See this image and copyright information in PMC

References

    1. Ahlstrom A, Tallgren M, Peltonen S, Rasanen P, Pettila V. Survival and quality of life of patients requiring acute renal replacement therapy. Intensive Care Med. 2005;31:1222–1228. doi: 10.1007/s00134-005-2681-6. - DOI - PubMed
    1. Bagshaw SM, Laupland KB, Doig CJ, Mortis G, Fick GH, Mucenski M, Godinez-Luna T, Svenson LW, Rosenal T. Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study. Crit Care. 2005;9:R700–R709. doi: 10.1186/cc3879. - DOI - PMC - PubMed
    1. Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, Kellum JA. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care. 2006;10:R73. doi: 10.1186/cc4915. - DOI - PMC - PubMed
    1. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C. Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813–818. doi: 10.1001/jama.294.7.813. - DOI - PubMed
    1. Cruz DN, Bolgan I, Perazella MA, Bonello M, de Cal M, Corradi V, Polanco N, Ocampo C, Nalesso F, Piccinni P, Ronco C. North East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEiPHROS-AKI): targeting the problem with the RIFLE Criteria. Clin J Am Soc Nephrol. 2007;2:418–425. doi: 10.2215/CJN.03361006. - DOI - PubMed

Publication types