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Renal replacement therapy for AKI: When? How much? When to stop?
- Source :
- Best practiceresearch. Clinical anaesthesiology. 31(3)
- Publication Year :
- 2017
-
Abstract
- Severe acute kidney injury (AKI) requiring renal replacement therapy (RRT) is a serious clinical disorder in the intensive care unit (ICU), occurring in a significant proportion of critically ill patients. However, many questions remain about the optimal administration of RRT with regard to several important considerations, including treatment dose, timing of treatment initiation and cessation, therapy mode, type of anticoagulation, and management of fluid overload. While Level 1 evidence exists for RRT dosing in AKI, all the studies contributing to this evidence base employed fixed-dose regimens throughout a patient's continuous RRT (CRRT) course, without regard for the possibility of individualizing treatment dose according to the clinical status of a given patient at a specific time. As opposed to CRRT dose, no consensus about the timing of RRT in critically ill AKI patients exists currently. While numerous clinical trials over the past 40 years have attempted to assess "early" versus "late" initiation of RRT, they have been plagued by a myriad of methodological problems, including their largely observational nature and the widely varying definitions of early and late initiation. Although questions about the appropriate timing of CRRT discontinuation arise very frequently in clinical practice, even less information is available in the literature to guide this important decision. The aim of this review is to provide a comprehensive update on RRT delivery to critically ill AKI patients, with specific attention paid to treatment dose and timing and emphasis on addressing the practical questions that arise in daily clinical practice.
- Subjects :
- medicine.medical_specialty
Time Factors
medicine.medical_treatment
Critical Illness
030232 urology & nephrology
urologic and male genital diseases
Severity of Illness Index
law.invention
03 medical and health sciences
0302 clinical medicine
law
medicine
Humans
Renal replacement therapy
Dosing
Precision Medicine
Intensive care medicine
business.industry
Acute kidney injury
Anticoagulants
030208 emergency & critical care medicine
Acute Kidney Injury
medicine.disease
Intensive care unit
female genital diseases and pregnancy complications
Discontinuation
Clinical trial
Renal Replacement Therapy
Intensive Care Units
Anesthesiology and Pain Medicine
Observational study
Hemodialysis
business
Subjects
Details
- ISSN :
- 18781608
- Volume :
- 31
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Best practiceresearch. Clinical anaesthesiology
- Accession number :
- edsair.doi.dedup.....151a963c3f7497471831ea8f4704d23b