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Renal replacement therapy in intensive care unit: a narrative review
Klouche Kada1,2, Gaudry Stéphane3, Naudin Jerôme4
1Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, Montpellier, France.
Annals of Intensive Care
|May 27, 2026
Summary
Acute kidney injury (AKI) is a growing concern in ICUs, often linked to sepsis and organ failure. Effective management of temporary renal replacement therapy (RRT) is crucial for survival in severe AKI cases.
Area of Science:
- Nephrology
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) is increasingly prevalent in hospitalized patients, especially in intensive care units (ICUs).
- The epidemiological profile of AKI has shifted, often presenting as multifactorial, septic, and associated with multiple organ failures.
- Severe AKI, particularly when requiring renal replacement therapy (RRT), carries a high mortality rate of 30-50%.
Purpose of the Study:
- To provide guidelines for the use of RRT in critically ill adult and pediatric patients.
- To inform therapeutic decisions regarding RRT by detailing cost, efficacy, limitations, and risks of various methods.
- To support the development of French consensus conference guidelines for RRT in critical care.
Main Methods:
- A narrative review conducted by an expert panel.
- The review was presented to the jury of the French consensus conference.
- Exclusion of AKI cases related to acute intoxication.
Main Results:
- Temporary RRT is a critical component of comprehensive care for severe AKI.
- RRT must be integrated with support for other vital functions, including cardio-circulatory, respiratory, and nutritional support.
- Mastery of diverse RRT methods and understanding their specific profiles are essential for therapeutic decision-making.
Conclusions:
- Guidelines are needed for the appropriate application of RRT in critically ill patients with AKI.
- A thorough understanding of RRT methods is necessary for optimal patient outcomes.
- Integrated care addressing multiple organ systems is paramount in managing severe AKI requiring RRT.
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