Assessing and delivering dialysis dose in acute kidney injury

Assessing and delivering dialysis dose in acute kidney injury (AKI) has emerged as an important issue in the management of critically ill patients. There is ongoing debate on how dose of dialysis should be expressed and measured. Most studies have focused on clearance of small molecules (blood urea nitrogen) as a marker of delivered dose and for establishing dose-outcome relationships. Recent evidence has shown that other markers may also be important to consider, as acid-base balance and fluid overload have emerged as important factors contributing to outcomes. In this review, we provide an evaluation of current approaches to prescribing and delivering dialysis dose in AKI, identify gaps in practice and propose an integrated approach to optimize dose delivery in dialysis with a goal to improve outcomes.