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
Review
. 2019 Jul 16:2019:6948710.
doi: 10.1155/2019/6948710. eCollection 2019.

Renal Replacement Therapy in the Critical Care Setting

Adeel Rafi Ahmed  1 , Ayanfeoluwa Obilana  2 , David Lappin  3
Affiliations
Review

Renal Replacement Therapy in the Critical Care Setting

Adeel Rafi Ahmed et al. Crit Care Res Pract. .

Abstract

Renal replacement therapy (RRT) is frequently required to manage critically ill patients with acute kidney injury (AKI). There is limited evidence to support the current practice of RRT in intensive care units (ICUs). Recently published randomized control trials (RCTs) have further questioned our understanding of RRT in critical care. The optimal timing and dosing continues to be debatable; however, current evidence suggests delayed strategy with less intensive dosing when utilising RRT. Various modes of RRT are complementary to each other with no definite benefits to mortality or renal function preservation. Choice of anticoagulation remains regional citrate anticoagulation in continuous renal replacement therapy (CRRT) with lower bleeding risk when compared with heparin. RRT can be used to support resistant cardiac failure, but evolving therapies such as haemoperfusion are currently not recommended in sepsis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no potential conflicts of interest.

Figures

Figure 1
Figure 1
Summary of evidence investigating CRRT dosing(ml/kg/hr). Red box: supporting high effluent flow rate. Green box: supporting lower effluent flow rate.
See this image and copyright information in PMC

References

    1. Chertow G. M., Burdick E., Honour M., Bonventre J. V., Bates D. W. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. Journal of the American Society of Nephrology. 2005;16(11):3365–3370. doi: 10.1681/asn.2004090740. - DOI - PubMed
    1. Ronco C., Zanella M., Brendolan A., et al. Management of severe acute renal failure in critically ill patients: an international survey in 345 centres. Nephrology Dialysis Transplantation. 2001;16(2):230–237. doi: 10.1093/ndt/16.2.230. - DOI - PubMed
    1. Mehta R. L. Renal-replacement therapy in the critically ill - does timing matter? New England Journal of Medicine. 2016;375(2):175–176. doi: 10.1056/nejme1606125. - DOI - PubMed
    1. Bagshaw S. M., Wald R., Barton J., et al. Clinical factors associated with initiation of renal replacement therapy in critically ill patients with acute kidney injury-a prospective multicenter observational study. Journal of Critical Care. 2012;27(3):268–275. doi: 10.1016/j.jcrc.2011.06.003. - DOI - PubMed
    1. Clark E., Wald R., Adeera L., et al. Timing the initiation of renal replacement therapy for acute kidney injury in Canadian intensive care units: a multicentre observational study. Canadian Journal of Anesthesia/Journal Canadien D’anesthésie. 2012;59(9):861–870. doi: 10.1007/s12630-012-9750-4. - DOI - PubMed

LinkOut - more resources