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Ultrafiltration in critically ill patients treated with kidney replacement therapy
Raghavan Murugan1,2, Rinaldo Bellomo3, Paul M Palevsky4,5
1The Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. muruganr@upmc.edu.
Nature Reviews. Nephrology
|November 12, 2020
Summary
Managing fluid overload in critically ill patients with acute kidney injury is complex. Moderate rates of net ultrafiltration during continuous kidney replacement therapy may reduce mortality and organ injury compared to slow or fast rates.
Area of Science:
- Nephrology
- Critical Care Medicine
- Cardiology
Background:
- Fluid overload is a significant challenge in critically ill patients with acute kidney injury.
- Clinical guidelines recommend ultrafiltration for fluid removal during kidney replacement therapy, but it carries risks.
Purpose of the Study:
- To evaluate the association between different rates of net ultrafiltration (UFNET) and patient outcomes.
- To explore the impact of UFNET rates on mortality, cardiac arrhythmias, and organ ischemia.
Main Methods:
- Review of emerging evidence from observational and experimental studies.
- Analysis of net fluid removal rates (UFNET) during continuous kidney replacement therapy and intermittent hemodialysis.
Main Results:
- Both slow and fast UFNET rates are linked to increased mortality compared to moderate rates.
- Fast UFNET rates are associated with a higher risk of cardiac arrhythmias and potential organ ischemia (heart, brain, kidney, gut).
Conclusions:
- Prescribing UFNET based on body weight and close monitoring of hemodynamics is crucial.
- Further randomized trials are needed to confirm if moderate UFNET rates improve outcomes and reduce organ injury in critically ill patients.
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