Delivering optimal renal replacement therapy to critically ill patients with acute kidney injury

Ron Wald; William Beaubien-Souligny; Rahul Chanchlani; Edward G Clark; Javier A Neyra; Marlies Ostermann; Samuel A Silver; Suvi Vaara; Alexander Zarbock; Sean M Bagshaw

doi:10.1007/s00134-022-06851-6

Delivering optimal renal replacement therapy to critically ill patients with acute kidney injury

Intensive Care Med. 2022 Oct;48(10):1368-1381. doi: 10.1007/s00134-022-06851-6. Epub 2022 Sep 6.

Authors

Ron Wald^{1

2}, William Beaubien-Souligny³, Rahul Chanchlani⁴, Edward G Clark⁵, Javier A Neyra⁶, Marlies Ostermann⁷, Samuel A Silver⁸, Suvi Vaara⁹, Alexander Zarbock¹⁰, Sean M Bagshaw¹¹

Affiliations

¹ Division of Nephrology, St. Michael's Hospital and the University of Toronto, 61 Queen Street East, 9-140, Toronto, ON, M5C 2T2, Canada. Ron.wald@unityhealth.to.
² Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. Ron.wald@unityhealth.to.
³ Division of Nephrology, Centre Hospitalier de L'Université de Montréal, Montréal, QC, Canada.
⁴ Division of Pediatric Nephrology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
⁵ Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁶ Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA.
⁷ Department of Critical Care Medicine, Guys and St. Thomas Hospital, London, UK.
⁸ Division of Nephrology, Kingston Health Sciences Center, Queen's University, Kingston, ON, Canada.
⁹ Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
¹⁰ Department of Anesthesiology, Intensive Care and Pain Medicine, Muenster, Germany.
¹¹ Department of Critical Care Medicine, University of Alberta and Alberta Health Services, Edmonton, AB, Canada.

PMID: 36066597
DOI: 10.1007/s00134-022-06851-6

Abstract

Critical illness is often complicated by acute kidney injury (AKI). In patients with severe AKI, renal replacement therapy (RRT) is deployed to address metabolic dysfunction and volume excess until kidney function recovers. This review is intended to provide a comprehensive update on key aspects of RRT prescription and delivery to critically ill patients. Recently completed trials have enhanced the evidence base regarding several RRT practices, most notably the timing of RRT initiation and anticoagulation for continuous therapies. Better evidence is still needed to clarify several aspects of care including optimal targets for ultrafiltration and effective strategies for RRT weaning and discontinuation.

Keywords: Acute kidney injury; Clinical trials; Intensive care unit; Renal replacement therapy.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Acute Kidney Injury*
Critical Illness* / therapy
Humans
Intensive Care Units
Renal Replacement Therapy