Optimum renal care in critically ill patients

Area of Science:

• Critical care medicine
• Nephrology
• Pharmacology

Background:

• Critically ill patients frequently experience acute kidney injury (AKI).
• Optimal management strategies for renal support in this population are evolving.

Purpose of the Study:

• To review and synthesize current evidence on optimal renal care for critically ill patients.
• To provide guidance on hemodynamics, fluid therapy, vasopressors, and kidney replacement therapy.

Main Methods:

• Literature review of recent studies and guidelines.
• Synthesis of evidence regarding hemodynamic optimization, fluid management, vasopressor use, and kidney replacement therapy (KRT).
• Discussion of medication stewardship and emerging technologies.

Main Results:

• Balanced crystalloids are preferred for hemodynamic optimization, except in traumatic brain injury.
• Restrictive fluid strategies may benefit patients with advanced chronic kidney disease or on dialysis.
• Norepinephrine is first-line; vasopressin and angiotensin II roles are under investigation.
• Personalized dialysis timing and preference for continuous renal replacement therapy (CRRT) in unstable patients.
• Optimal ultrafiltration net (UFNET) rates are 1.0–1.5 ml/kg/h.
• Nephrotoxin stewardship and multidisciplinary collaboration are crucial.
• Novel biomarkers and AI offer promise for precision medicine.

Conclusions:

• Optimal renal care requires a holistic approach.
• Key elements include hemodynamic management, fluid therapy, vasoactive agents, KRT, medication stewardship, and innovative technologies.