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      Prescribing Continuous Kidney Replacement Therapy in Acute Kidney Injury: A Narrative Review

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          Abstract

          Severe acute kidney injury is a common complication in critically ill patients, often necessitating support with a modality of kidney replacement therapy. Continuous kidney replacement therapies (CKRTs) have become a mainstay in the management of patients with acute kidney injury in the intensive care unit. Understanding the fundamentals of CKRT is necessary to safely and effectively prescribe treatment. In this narrative review, we summarize critical aspects of CKRT management, including selection of the mode of therapy; choice of hemofilter/hemodialyzer used; determination of the blood flow rate, composition and flow rates of dialysate and/or replacement fluids, and the ultrafiltration rate; and use and methods of anticoagulation. Requirements for vascular access and appropriate monitoring and dose adjustment of medications and a plan for monitoring the delivery of therapy and ensuring appropriate nutritional management are also discussed.

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          KDIGO Clinical Practice Guidelines for Acute Kidney Injury

          Arif Khwaja, A. Khwaja (2012)
          Article 0 comments Cited 2128 times – based on 0 reviews     Review now
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            Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study.

            Eric Hoste, Sean Bagshaw, Rinaldo Bellomo … (2015)
            Current reports on acute kidney injury (AKI) in the intensive care unit (ICU) show wide variation in occurrence rate and are limited by study biases such as use of incomplete AKI definition, selected cohorts, or retrospective design. Our aim was to prospectively investigate the occurrence and outcomes of AKI in ICU patients.
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              Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group

              Rinaldo Bellomo, Claudio Ronco, John A. Kellum … (2004)
              Introduction There is no consensus definition of acute renal failure (ARF) in critically ill patients. More than 30 different definitions have been used in the literature, creating much confusion and making comparisons difficult. Similarly, strong debate exists on the validity and clinical relevance of animal models of ARF; on choices of fluid management and of end-points for trials of new interventions in this field; and on how information technology can be used to assist this process. Accordingly, we sought to review the available evidence, make recommendations and delineate key questions for future studies. Methods We undertook a systematic review of the literature using Medline and PubMed searches. We determined a list of key questions and convened a 2-day consensus conference to develop summary statements via a series of alternating breakout and plenary sessions. In these sessions, we identified supporting evidence and generated recommendations and/or directions for future research. Results We found sufficient consensus on 47 questions to allow the development of recommendations. Importantly, we were able to develop a consensus definition for ARF. In some cases it was also possible to issue useful consensus recommendations for future investigations. We present a summary of the findings. (Full versions of the six workgroups' findings are available on the internet at ) Conclusion Despite limited data, broad areas of consensus exist for the physiological and clinical principles needed to guide the development of consensus recommendations for defining ARF, selection of animal models, methods of monitoring fluid therapy, choice of physiological and clinical end-points for trials, and the possible role of information technology.
              Article 0 comments Cited 426 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Paul M. Palevsky
                Journal
                Journal ID (nlm-ta): Kidney Med
                Journal ID (iso-abbrev): Kidney Med
                Title: Kidney Medicine
                Publisher: Elsevier
                ISSN (Electronic): 2590-0595
                Publication date PMC-release: 18 July 2021
                Publication date Collection: Sep-Oct 2021
                Publication date (Electronic): 18 July 2021
                Volume: 3
                Issue: 5
                Pages: 827-836
                Affiliations
                [1 ]Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
                [2 ]Kidney Medicine Section, Medical Service, VA Pittsburgh Healthcare System, Pittsburgh, PA
                [3 ]Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
                Author notes
                [∗ ] Address for Correspondence: Paul M. Palevsky, MD, Rm 7E123 (111F-U), VA Pittsburgh Healthcare System, University Dr, Pittsburgh, PA 15240. palevsky@ 123456pitt.edu
                [∗]

                Although the word convection has been used in nephrology literature to describe clearance during hemofiltration, convection technically refers to the movement of fluids due to thermal gradients or other physical forces, whereas advection refers to the movement of entrained matter or solute due to the flow of solvent.

                Article
                Publisher Item ID: S2590-0595(21)00159-X
                DOI: 10.1016/j.xkme.2021.05.006
                PMC ID: 8515066
                SO-VID: 918cdda4-3ee2-4c5c-926d-8b4c8666238c
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Categories
                Subject: Review

                Keywords: acute kidney injury,continuous renal replacement therapy,continuous kidney replacement therapy,hemodialysis,hemofiltration,continuous venovenous hemofiltration,hemodiafiltration,ultrafiltration,continuous venovenous hemodialysis,continuous venovenous hemodiafiltration
                Data availability:
                Keywords: acute kidney injury, continuous renal replacement therapy, continuous kidney replacement therapy, hemodialysis, hemofiltration, continuous venovenous hemofiltration, hemodiafiltration, ultrafiltration, continuous venovenous hemodialysis, continuous venovenous hemodiafiltration

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