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Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform

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Volume Management with Kidney Replacement Therapy in the Critically Ill Patient.

Christina H Wang^1,2, Kevin Fay^1,3, Michael G S Shashaty^2,4

¹Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Clinical Journal of the American Society of Nephrology : CJASN

|April 5, 2023

Summary

Fluid overload is a risk in critical illness. Dynamic protocols for fluid removal using kidney replacement therapy (KRT) are needed, focusing on frequent reassessment rather than fixed rates.

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Area of Science:

Nephrology
Critical Care Medicine
Fluid Management

Background:

Intravenous fluid administration is crucial but can lead to fluid overload.
Managing fluid balance in critically ill patients, especially those requiring kidney replacement therapy (KRT), is complex.
Existing fluid management strategies need re-evaluation for patients needing KRT.

Approach:

This review applies fluid management concepts to patients requiring KRT.
It examines a phased care model for ultrafiltration during KRT in distributive shock.
The approach includes reviewing prospective KRT trials and retrospective studies on ultrafiltration and mortality.

Key Points:

Optimal fluid management in critical illness is dynamic and patient-specific.
Ultrafiltration during KRT is a key method for fluid removal.
Current data suggest dynamic protocols over fixed fluid removal rates are superior.

Conclusions:

Fluid management in critically ill patients needing KRT requires frequent reassessment of fluid responsiveness and tolerance.
Dynamic protocols involving cycles of adjustment are essential for optimal outcomes.
Future innovations in assessing fluid status will enhance ultrafiltration management.