Renal Replacement Therapy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendation.

Area of Science:

• Critical Care Medicine
• Nephrology
• Renal Replacement Therapy

Background:

• Acute kidney injury (AKI) is a significant contributor to morbidity and mortality in intensive care unit (ICU) patients.
• Management of AKI often involves hemodynamic optimization, but some patients require renal replacement therapy (RRT).
• Continuous RRT is often preferred for hemodynamically unstable patients requiring vasoactive drugs.

Purpose of the Study:

• To provide practice recommendations for optimizing the initiation and management of RRT in adult ICU patients with AKI.
• To guide intensivists in the effective and prompt management of AKI patients requiring RRT.
• To foster a multidisciplinary approach involving intensivists and nephrologists in AKI care.

Main Methods:

• Development of practice recommendations through expert panel discussions among intensivists and nephrologists.
• Review of existing guidelines and literature to support the recommendations.
• Focus on the role of the intensivist in all levels of AKI patient care, including RRT prescription and modification.

Main Results:

• Recommendations emphasize the crucial role of the trained intensivist in managing AKI patients requiring RRT.
• Highlights the importance of timely RRT initiation, modification based on metabolic needs, and discontinuation upon renal recovery.
• Stresses the paramount importance of nephrology team involvement in AKI management.

Conclusions:

• Trained intensivists are central to the effective management of AKI patients requiring RRT in ICUs.
• Collaboration between intensivists and nephrologists is essential for optimal patient outcomes.
• Appropriate documentation of RRT practices is recommended for quality assurance and future research.