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Delivering optimal renal replacement therapy to critically ill patients with acute kidney injury

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Abstract

Critical illness is often complicated by acute kidney injury (AKI). In patients with severe AKI, renal replacement therapy (RRT) is deployed to address metabolic dysfunction and volume excess until kidney function recovers. This review is intended to provide a comprehensive update on key aspects of RRT prescription and delivery to critically ill patients. Recently completed trials have enhanced the evidence base regarding several RRT practices, most notably the timing of RRT initiation and anticoagulation for continuous therapies. Better evidence is still needed to clarify several aspects of care including optimal targets for ultrafiltration and effective strategies for RRT weaning and discontinuation.

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Acknowledgements

SMB is supported by a Canada Research Chair in Critical Care Outcomes and Systems Evaluation.

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Authors and Affiliations

  1. Division of Nephrology, St. Michael’s Hospital and the University of Toronto, 61 Queen Street East, 9-140, Toronto, ON, M5C 2T2, Canada

    Ron Wald

  2. Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada

    Ron Wald

  3. Division of Nephrology, Centre Hospitalier de L’Université de Montréal, Montréal, QC, Canada

    William Beaubien-Souligny

  4. Division of Pediatric Nephrology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada

    Rahul Chanchlani

  5. Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada

    Edward G. Clark

  6. Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA

    Javier A. Neyra

  7. Department of Critical Care Medicine, Guys and St. Thomas Hospital, London, UK

    Marlies Ostermann

  8. Division of Nephrology, Kingston Health Sciences Center, Queen’s University, Kingston, ON, Canada

    Samuel A. Silver

  9. Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

    Suvi Vaara

  10. Department of Anesthesiology, Intensive Care and Pain Medicine, Muenster, Germany

    Alexander Zarbock

  11. Department of Critical Care Medicine, University of Alberta and Alberta Health Services, Edmonton, AB, Canada

    Sean M. Bagshaw

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Correspondence to Ron Wald.

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Conflicts of interest

RW has received unrestricted research support and speaker fees from Baxter and consulting fees from Lilly. JAN has received consulting fees from Baxter. SAS has received speaking fees from Baxter. SMB has received unrestricted research support and fees for speaking and scientific advisory from Baxter, fees for scientific advisory from Novartis, fees for data safety monitoring for I-SPY-COVID, and fees for scientific advisory and clinical adjudication from BioPorto. MO has received speaker honoraria and research funding from Baxter, Fresenius Medical and Biomerieux. AZ has received unrestricted research support and speaker fees from Baxter, Fresenius, and BioMerieux.

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Wald, R., Beaubien-Souligny, W., Chanchlani, R. et al. Delivering optimal renal replacement therapy to critically ill patients with acute kidney injury. Intensive Care Med 48, 1368–1381 (2022). https://doi.org/10.1007/s00134-022-06851-6

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