Abstract
Critically ill patients with acute kidney injury (AKI) often require renal replacement therapy (RRT). The choice of the modality of RRT depends on the clinical situation, especially the hemodynamic status of the patient. The dose of RRT is a contentious topic, with conflicting evidence from clinical trials. This chapter reviews current evidence behind RRT dosing in critically ill patients with AKI.
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References
Ronco C, Ricci Z. Renal replacement therapies: physiological review. Intensive Care Med. 2008;34(12):2139–46.
Vásquez Jiménez E, Anumudu SJ, Neyra JA. Dose of continuous renal replacement therapy in critically ill patients: a bona fide quality indicator. Nephron. 2021;145(2):91–8.
Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet. 2000;356(9223):26–30.
Saudan P, Niederberger M, De Seigneux S, Romand J, Pugin J, Perneger T, et al. Adding a dialysis dose to continuous hemofiltration increases survival in patients with acute renal failure. Kidney Int. 2006;70(7):1312–7.
Palevsky PM, Zhang JH, O’Connor TZ, Chertow GM, Crowley ST, et al. For the VA/NIH acute renal failure trial network. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359(1):7–20.
Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, et al. For the RENAL replacement therapy study investigators. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med. 2009;361(17):1627–38.
Fayad AI, Buamscha DG, Ciapponi A. Intensity of continuous renal replacement therapy for acute kidney injury. Cochrane Database Syst Rev. 2016;10:CD010613.
Wang Y, Gallagher M, Li Q, Lo S, Cass A, Finfer S, et al. Renal replacement therapy intensity for acute kidney injury and recovery to dialysis independence: a systematic review and individual patient data meta-analysis. Nephrol Dial Transplant. 2018;33(6):1017–24.
Jun M, Heerspink HJL, Ninomiya T, Gallagher M, Bellomo R, Myburgh J, et al. Intensities of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis. Clin J Am Soc Nephrol. 2010;5(6):956–63.
Macedo E, Claure-Del Granado R, Mehta RL. Effluent volume and dialysis dose in CRRT: time for reappraisal. Nat Rev Nephrol. 2011;8(1):57–60.
Venkataraman R, Kellum JA, Palevsky P. Dosing patterns for continuous renal replacement therapy at a large academic medical center in the United States. J Crit Care. 2002;17(4):246–50.
Vesconi S, Cruz DN, Fumagalli R, Kindgen-Milles D, Monti G, Marinho A, et al. Delivered dose of renal replacement therapy and mortality in critically ill patients with acute kidney injury. Crit Care. 2009;13(2):R57.
Kellum JA, Lameire N, Aspelin P, Barsoum RS, Burdmann EA, Goldstein SL, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2(1):1–138.
Ronco C, Ricci Z, Bellomo R. Importance of increased ultrafiltration volume and impact on mortality: sepsis and cytokine story and the role of continuous veno-venous haemofiltration. Curr Opin Nephrol Hypertens. 2001;10(6):755–61.
Joannes-Boyau O, Dewitte A, Honoré PM. High-volume hemofiltration in the intensive care unit. In: Ronco C, Bellomo R, Kellum JA, editors. Critical care nephrology. 2nd ed. Philadelphia, PA: Elsevier; 2019. p. 1034–1037.e2. https://linkinghub.elsevier.com/retrieve/pii/B9780323449427001710.
Combes A, Bréchot N, Amour J, Cozic N, Lebreton G, Guidon C, et al. Early high-volume hemofiltration versus standard care for post-cardiac surgery shock. The HEROICS study. Am J Respir Crit Care Med. 2015;192(10):1179–90.
Zhang P, Yang Y, Lv R, Zhang Y, Xie W, Chen J. Effect of the intensity of continuous renal replacement therapy in patients with sepsis and acute kidney injury: a single-center randomized clinical trial. Nephrol Dial Transplant. 2012;27(3):967–73.
Joannes-Boyau O, Honoré PM, Perez P, Bagshaw SM, Grand H, Canivet JL, et al. High-volume versus standard-volume haemofiltration for septic shock patients with acute kidney injury (IVOIRE study): a multicentre randomized controlled trial. Intensive Care Med. 2013;39(9):1535–46.
Lehner GF, Wiedermann CJ, Joannidis M. High-volume hemofiltration in critically ill patients: a systematic review and meta-analysis. Minerva Anestesiol. 2014;80(5):595–609.
Clark E, Molnar AO, Joannes-Boyau O, Honoré PM, Sikora L, Bagshaw SM. High-volume hemofiltration for septic acute kidney injury: a systematic review and meta-analysis. Crit Care. 2014;18(1):R7.
Borthwick EM, Hill CJ, Rabindranath KS, Maxwell AP, McAuley DF, Blackwood B. High-volume haemofiltration for sepsis in adults. Cochrane Database Syst Rev. 2017;1:CD008075.
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Chacko, J., Pawar, S., Seppelt, I., Brar, G. (2023). Optimizing the Dose of Renal Replacement Therapy. In: Controversies in Critical Care. Springer, Singapore. https://doi.org/10.1007/978-981-19-9940-6_27
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DOI: https://doi.org/10.1007/978-981-19-9940-6_27
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