Abstract
Acute renal failure (ARF) in critically ill patients is currently very frequent and requires renal replacement therapy (RRT) in many patients. During the last 15 years, several studies have considered important issues regarding the use of RRT in ARF, like the time to initiate the therapy, the dialysis dose, the types of catheter, the choice of technique, and anticoagulation. However, despite an abundant literature, conflicting results do not provide evidence on RRT implementation. We present herein recommendations for the use of RRT in adult and pediatric intensive care developed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system by an expert group of French Intensive Care Society (SRLF), with the participation of the French Society of Anesthesia and Intensive Care (SFAR), the French Group for Pediatric Intensive Care and Emergencies (GFRUP), and the French Dialysis Society (SFD). The recommendations cover 4 fields: criteria for RRT initiation, technical aspects (access routes, membranes, anticoagulation, reverse osmosis water), practical aspects (choice of the method, peritoneal dialysis, dialysis dose, adjustments), and safety (procedures and training, dialysis catheter management, extracorporeal circuit set-up). These recommendations have been designed on a practical point of view to provide guidance for intensivists in their daily practice.
Highlights
The prevalence of acute renal failure (ARF) in intensive care, in an unselected population, is high—about 40 %— and a renal replacement therapy technique is required in just under 20 % of patients presenting ARF [1]
Most aspects of renal replacement therapy (RRT) in adult or pediatric ICU have been considered in these recommendations, but some of them have been unheeded in regard to the lack of data in the literature or the prioritization decided by the panel expert
These recommendations were drawn up by a panel of experts brought together by the SRLF in collaboration with scientific societies in disciplines that contribute to the management of acute renal failure by RRT: French Society of Anesthesia and Intensive Care (SFAR), French Group for Pediatric Intensive Care and Emergencies (GFRUP) and the French Dialysis Society (SFD)
Summary
The prevalence of acute renal failure (ARF) in intensive care, in an unselected population, is high—about 40 %— and a renal replacement therapy technique is required in just under 20 % of patients presenting ARF [1]. (Expert opinion) Strong agreement On the basis of old data on end-stage renal failure patients on dialysis, the CDC (http://www.cdc.gov/dialysis/guidelines) and KDOQI (http://www.kidney.org/ professionals/kdoqi/guidelines_commentaries.cfm) recommend avoiding the placement of temporary RRT catheters at the subclavian site because of a risk of stenosis of the subclavian and axillary veins, which could compromise the function of, or the future use of, a permanent access such as an arteriovenous fistula if acute renal. A meta-analysis of 11 randomized studies in patients with end-stage renal failure found no difference between unfractionated heparin and low-molecular-weight heparin in terms of bleeding complications or antithrombotic efficacy [96].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
