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
. 2025 Jul 16;15(1):100.
doi: 10.1186/s13613-025-01517-0.

Renal replacement therapy in an intensive care unit: guidelines from the SRLF-GFRUP consensus conference

Mercè Jourdain  1 , Ines Gragueb Chatti  2 , Brahim Housni  3 , Pierre Jaquet  4 , Mélissa Jezequel  5 , Oumar Kane  6 , Béatrice La Combe  7 , Mickael Landais  8 , Mehdi Marzouk  9 , Etienne de Montmollin  10 , Guillaume Mortamet  11 , Mai-Anh Nay  12 , Charlotte Salmon-Gandonnière  13 , Sophie Perinel-Ragey  14 , Jérôme Rambaud  15 , Joanna Schmitt  16 , Marie Simon  17 , Julie Starck  18 , Arnaud W Thille  19 , Pierre-François Dequin  20
Affiliations
Review

Renal replacement therapy in an intensive care unit: guidelines from the SRLF-GFRUP consensus conference

Mercè Jourdain et al. Ann Intensive Care. .

Abstract

Background: Although largely used, the place of extracorporeal renal replacement therapy (RRT) in acute kidney injury (AKI) in intensive care unit (ICU) patients has yet to be clarified. The French Intensive Care Society (Société de Réanimation de Langue Française, SRLF) and the French Pediatric Group of Intensive Care and Emergency (Groupe Francophone de Réanimation et d'Urgence Pédiatrique, GFRUP) organized a consensus conference in November 2024.

Methods: A committee, without any conflict of interest (CoI) on the subject, defined seven generic questions and drew up a list of sub questions according to the population, intervention, comparison and outcomes (PICO) model. An independent work group reviewed literature using predefined keywords. The quality of the data was assessed using the GRADE methodology. Eighteen experts in the field from both societies proposed their own answers in a public session and answered questions from the jury (a panel of 14 critical-care medicine physicians and a nurse) and the public. The jury then met for 48 h to write out and vote on its recommendations.

Results: The panel provided 45 statements addressing seven questions. In patients, adults or children, admitted to the ICU with AKI (1) What are the indications for RRT, when should it be initiated, and within what timeframe? (2) What are the advantages/disadvantages of the different RRT modalities in ICU, and based on what criteria should they be chosen? (3) Which dose of dialysis should be prescribed for ICU patients? (4) How to prescribe, adjust and monitor each RRT technique? (5) Which vascular access technique should be preferred (insertion site, catheter type and length)? (6) How to prevent circuit thrombosis? (7) What are the criteria to consider weaning from RRT and how can it be achieved?

Conclusions: These recommendations should optimize the prescription and use of RRT during AKI in ICUs for both adult and pediatric patients.

Keywords: Acute renal failure; Consensus conference; Continuous renal replacement therapy; Extracorporeal renal replacement therapy; Guidelines; Intermittent hemodialysis.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. None of the societies or experts influenced the jury's decisions. Consent for publication: Not applicable. Competing interests: MJ: honoraria for lectures from Alexion. IGC: no competing interest. BH: no competing interest. PJ: no competing interest. MJ: no competing interest. OK: no competing interest. BLC: no competing interest. MK: no competing interest. MM: no competing interest. EdM: no competing interest. GM: no competing interest. MAN: received research support (grants and material) and personal fees (payment for presentations) from Fisher&Paykel, support (transportation, accommodation and conference registration) from Pfizer. CSG: honoraria for lectures from Sanofi Aventis. SPR: no competing interest. JR: no competing interest. JS: no competing interest. MS: no competing interest. JS: no competing interest. AWT: received grants and personal fees (payments for lectures and travel/accommodation expense to attend scientific meetings) from Fisher&Paykel. PFD: received research support in the form of equipment loans from Fisher & Paykel and Aerogen, consulting member of Aridis Pharmaceuticals, support (transport, accommodation and conference registration) from AOP Health.

References

    1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO. Clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2024;2024(105):S117-314. - PubMed
    1. Hoste EAJ, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensiv Care Med. 2015;41:1411–23. - PubMed
    1. Ronco C, Bellomo R, Kellum JA. Acute kidney injury. Lancet. 2019;394:1949–64. - PubMed
    1. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813–8. - PubMed
    1. Bagshaw SM, Darmon M, Ostermann M, Finkelstein FO, Wald R, Tolwani AJ, et al. Current state of the art for renal replacement therapy in critically ill patients with acute kidney injury. Intensiv Care Med. 2017;43:841–54. - PubMed

LinkOut - more resources