[Acute renal replacement therapy in the intensive care unit]

Area of Science:

• Nephrology
• Critical Care Medicine
• Intensive Care

Context:

• Acute renal replacement techniques are crucial in intensive care units.
• Intermittent hemodialysis and continuous hemofiltration are common modalities.
• Continuous techniques show potential benefits for critically ill patients.

Purpose:

• To review current evidence on acute renal replacement therapy in intensive care.
• To discuss the efficacy and optimal use of continuous versus intermittent techniques.
• To highlight areas of uncertainty and guide clinical practice.

Summary:

• No consistent mortality differences exist between continuous and intermittent renal replacement therapy.
• Unmodified cellulose membranes should be avoided due to uncertainties.
• A 'late' start for renal replacement therapy should generally be avoided.
• Continuous techniques require a filtration volume of at least 35 ml/kg/h.
• Mechanisms for hemodynamic improvements with continuous techniques are unclear.
• Evidence for improved survival with continuous techniques in non-renal insufficiency patients is lacking.

Impact:

• Informs clinical decisions regarding the choice and timing of renal replacement therapy.
• Suggests avoiding specific membrane types and delayed treatment initiation.
• Highlights the need for further research into the benefits and mechanisms of continuous techniques.
• Emphasizes the importance of adequate filtration volumes in continuous therapy.