[Renal Replacement Therapy in Acute Kidney Injury - Indication and Implementation]

Area of Science:

• Nephrology
• Critical Care Medicine

Background:

• Acute kidney injury (AKI) is a frequent complication in critically ill patients, impacting both short- and long-term prognoses.
• The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines provide recommendations for AKI management.
• AKI is defined and classified by KDIGO criteria based on serum creatinine and urine output changes.

Purpose of the Study:

• To summarize current KDIGO guidelines for the prevention and management of AKI in critically ill patients.
• To highlight the role of renal replacement therapy (RRT) in severe AKI.
• To address the lack of clear recommendations for initiating RRT in progressive AKI without absolute indications.

Main Methods:

• Review of KDIGO guidelines for AKI.
• Analysis of recommendations for RRT initiation, techniques (continuous vs. intermittent), and anticoagulation strategies.
• Inclusion of specific effluent volume recommendations for continuous renal replacement therapy (CRRT) in AKI.

Main Results:

• KDIGO guidelines recommend preventive strategies for high-risk patients and immediate RRT initiation for absolute indications.
• No specific recommendations exist for initiating RRT in progressive AKI without absolute indications.
• Both continuous and intermittent RRT are viable, with CRRT preferred for hemodynamically unstable patients or those with increased intracranial pressure.
• Regional citrate anticoagulation is suggested for CRRT, and systemic heparin for intermittent RRT, despite weak evidence.
• A CRRT effluent volume of 20-25 ml/kg/h is recommended for AKI.

Conclusions:

• AKI necessitates adherence to KDIGO guidelines for optimal patient outcomes.
• Further research is needed to clarify RRT initiation timing in progressive AKI.
• Appropriate RRT modality and anticoagulation strategies are crucial for managing severe AKI.