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Published on: May 2, 2017
Review article: Renal support in critical illness
Sean M Bagshaw1, Rinaldo Bellomo, Prasad Devarajan
1Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada. bagshaw@ualberta.ca
Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|October 9, 2010
Summary
Early acute renal replacement therapy (RRT) in acute kidney injury (AKI) may improve survival, but high-dose RRT shows no benefit. Fluid overload worsens outcomes in critically ill patients needing RRT.
Area of Science:
- Nephrology
- Critical Care Medicine
- Renal Replacement Therapy
Background:
- Acute kidney injury (AKI) is a common complication in critically ill patients.
- Technological advancements have improved extracorporeal renal replacement therapy (RRT).
- RRT offers vital renal and non-renal organ support in critical illness.
Purpose of the Study:
- To provide a comprehensive update on established and emerging evidence in acute RRT for critically ill patients with AKI.
- To discuss technological innovations and their impact on RRT delivery.
- To address ongoing clinical questions in AKI management.
Main Methods:
- Review of recent technological innovations in extracorporeal RRT.
- Analysis of recent clinical trial data on RRT initiation and dosage.
- Examination of observational data on fluid accumulation and outcomes.
- Discussion of RRT applications in specific conditions like sepsis and liver failure.
Main Results:
- Earlier initiation of RRT in AKI may improve survival and renal recovery.
- Large trials indicate no additional benefit from augmented RRT dose delivery.
- Fluid accumulation in AKI patients is linked to poorer clinical outcomes.
- Key questions remain regarding optimal timing of RRT initiation/discontinuation.
Conclusions:
- Continued research and innovation in RRT are expected.
- Advancements aim to improve outcomes for critically ill patients with AKI.
- Further studies are needed to address unresolved clinical questions in RRT.
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