Abstract
The optimal management of renal replacement therapy (RRT) in acute kidney injury (AKI) remains uncertain. Although it is well accepted that initiation of RRT in patients with progressive azotemia prior to the development of overt uremic manifestations is associated with improved survival, whether there is benefit to even earlier initiation of therapy is uncertain. Although retrospective and observational studies have suggested improved survival with very early initiation of continuous RRT (CRRT), interpretation of these studies is confounded by their failure to include patients with AKI who recover renal function or die without ever receiving RRT. Several studies have suggested that more intensive delivery of CRRT during AKI is associated with improved survival, although results of trials have been inconsistent. Two large multicenter randomized clinical trials addressing this question are currently underway and should provide more definitive data within the next two years.
Highlights
The optimal management of renal replacement therapy (RRT) in acute kidney injury (AKI) is uncertain
This review focuses on the issue of timing and dose of continuous RRT (CRRT), summarizing recent data and suggesting avenues for future research, it should be recognized that many of the same issues apply to the management of intermittent hemodialysis in AKI
In the first of these prospective trials, 18 patients with posttraumatic AKI were alternately assigned to an intensive dialysis regimen to maintain the pre-dialysis BUN at AKI = acute kidney injury; BUN = blood urea nitrogen; CRRT = continuous RRT; CVVH = continuous venovenous hemofiltration; CVVHDF = continuous venovenous hemodiafiltration; ICU = intensive care unit; IHD = intermittent hemodialysis; RRT = renal replacement therapy
Summary
The optimal management of renal replacement therapy (RRT) in acute kidney injury (AKI) is uncertain. Two prospective clinical trials comparing early to late initiation of hemodialysis in AKI were conducted during the 1970s and 1980s [28,29].
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