Renal replacement therapy for acute kidney injury

Shigeo Negi,Yu Iwashita,Takashi Shigematu,Daisuke Koreeda,Sou Kobayashi

doi:10.1186/s41100-016-0043-1

Shigeo Negi, Yu Iwashita + Show 3 more

Open Access

https://doi.org/10.1186/s41100-016-0043-1

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Abstract

The annual incidence of acute kidney injury (AKI) has been increasing as the population ages. Despite advances in critical care and dialysis technology, the mortality remains unacceptably high in patients with AKI during the past few decades. Renal replacement therapy (RRT) is performed to treat patients with severe AKI and multiple organ failures, as well as to remove fluid in patients with fluid overload including those with acute heart failure and lung edema in the intensive care unit (ICU). The mortality in patients with AKI requiring RRT is higher than 50 %. RRT strategies in patients with AKI depend on various conditions. However, there is little consensus on when to start and stop RRT, its optimal dose, and the choice of different RRT modalities (intermittent versus (vs.) continuous) in patients with AKI. Patients with AKI in the ICU are preferentially treated with continuous rather than intermittent RRT (IRRT), usually because of hemodynamic stability and steady of solute clearance. At present, the type and dose of RRT are dependent on the experience of the attending clinicians, including intensivists and nephrologists.

Highlights

Acute kidney injury (AKI) is defined as a rapid decline in glomerular filtration rate occurring over a period of minutes to days, with retention of blood urea nitrogen and serum creatinine (SCr)
The survival at 15 days after discontinuation of CRRT was significantly lower in the lowest dose (41 %) than in the intermediate (57 %, p = 0.007) and highest (58 %, p = 0.0013) dose groups but did not differ in the latter two groups. These findings suggest that a filtration rate ≥35 mL/kg/h was recommended for critically ill patients with AKI requiring CRRT
This study showed that the patient survival was significantly higher in patients who received continuous veno-venous hemodiafiltration (CVVHDF) than continuous veno-venous hemofiltration (CVVHF), both at 28 days (59 vs. 39 %, p = 0.03) and 90 days (59 vs. 34 % p = 0.0005)

Summary

Background

Acute kidney injury (AKI) is defined as a rapid decline in glomerular filtration rate occurring over a period of minutes to days, with retention of blood urea nitrogen and serum creatinine (SCr). 4 % of ICU patients develop AKI requiring renal replacement therapy (RRT) [1]. Mortality in ICU patients with AKI severe enough to require RRT has been reported to be as high as 80 % [2, 3]. Several studies have examined the timing of RRT initiation in AKI patients in the ICU. It is unclear whether the early initiation of RRT improves survival and renal recovery rates [4,5,6,7,8,9]. The timing of RRT was assessed using conventional serum biomarkers (e.g., serum urea and SCr levels), urine volume, and the time from ICU admission to the start of RRT

RRT mode

Conclusions

Findings

20. The Kidney Disease