Renal replacement therapy in critically ill patients

Area of Science:

• Nephrology
• Critical Care Medicine
• Renal Replacement Therapy

Background:

• Acute renal failure (ARF) is prevalent in critically ill patients, carrying a mortality rate up to 60%.
• Practices and outcomes of renal replacement therapy (RRT) vary significantly across studies.
• The Acute Dialysis Quality Initiative's classification aids in understanding ARF epidemiology and outcomes.

Purpose of the Study:

• To update information on renal replacement therapy for critically ill patients.
• To review current treatment strategies and outcomes for acute renal failure in critical care.

Main Methods:

• Comprehensive literature search of Medline and PubMed up to June 2008.
• Inclusion of original studies, literature reviews, and book chapters.
• Synthesis of data to provide an overview of RRT in critically ill patients.

Main Results:

• A unified classification (RIFLE) improves the description of ARF epidemiology and outcomes.
• A direct relationship between dialysis dose and survival exists, with 35 mL/kg/h as a benchmark, though recent trials challenge this.
• Citrate as an anticoagulant in RRT can improve circuit patency and reduce bleeding but has complex setup and metabolic limitations.

Conclusions:

• The RIFLE classification accurately describes ARF epidemiology and outcomes in critically ill patients.
• The standard RRT dose of 35 mL/kg/h requires further validation from ongoing clinical trials.
• Overcoming challenges with citrate anticoagulation in RRT may be possible with pharmaceutical support.