Advertisement

Renal Replacement Therapy (RRT)

Chapter

Abstract

Elderly trauma patients are at particularly high risk for acute kidney injury because of injury-related hypotension and hypovolemia superimposed on decreased physiologic reserve. Aggressive fluid resuscitation should be balanced with other conditions which may limit how much volume an individual patient can tolerate. The initiation and withdrawal of renal replacement therapy in this population can be controversial. Guidelines exist to support decision making and resolving ethical conflicts related to renal support and palliative care.

Keywords

Chronic Kidney Disease Renal Replacement Therapy Acute Kidney Injury Multiple Organ Dysfunction Syndrome Intermittent Hemodialysis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Hsu CY, et al. Community-based incidence of acute renal failure. Kidney Int. 2007;72(2):208–12.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Feest TG, Round A, Hamad S. Incidence of severe acute renal failure in adults: results of a community based study. BMJ. 1993;306(6876):481–3.PubMedCrossRefGoogle Scholar
  3. 3.
    Pascual J, Liano F. Causes and prognosis of acute renal failure in the very old. Madrid Acute Renal Failure Study Group. J Am Geriatr Soc. 1998;46(6):721–5.PubMedGoogle Scholar
  4. 4.
    Uchino S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294(7):813–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Mehta RL, Chertow GM. Acute renal failure definitions and classification: time for change? J Am Soc Nephrol. 2003;14(8): 2178–87.PubMedCrossRefGoogle Scholar
  6. 6.
    Chertow GM, et al. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16(11): 3365–70.PubMedCrossRefGoogle Scholar
  7. 7.
    Himmelfarb J. Acute kidney injury in the elderly: problems and prospects. Semin Nephrol. 2009;29(6):658–64.PubMedCrossRefGoogle Scholar
  8. 8.
    Riviello ED, Christopher K. Critical care nephrology: acute renal failure in the intensive care unit. Nephrol Rounds. 2006;4(10).Google Scholar
  9. 9.
    Bellomo R, et al. Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4):R204–12.PubMedCrossRefGoogle Scholar
  10. 10.
    Dennen P, Douglas IS, Anderson R. Acute kidney injury in the intensive care unit: an update and primer for the intensivist. Crit Care Med. 2010;38(1):261–75.PubMedCrossRefGoogle Scholar
  11. 11.
    Uchino S, et al. An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med. 2006;34(7): 1913–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Chronopoulos A, et al. Acute kidney injury in elderly intensive care patients: a review. Intensive Care Med. 2010;36(9):1454–64.PubMedCrossRefGoogle Scholar
  13. 13.
    Joannidis M, et al. Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med. 2009;35(10):1692–702.PubMedCrossRefGoogle Scholar
  14. 14.
    Rosner MH. The pathogenesis of susceptibility to acute kidney injury in the elderly. Curr Aging Sci. 2009;2(2):158–64.PubMedCrossRefGoogle Scholar
  15. 15.
    Abdel-Kader K, Palevsky PM. Acute kidney injury in the elderly. Clin Geriatr Med. 2009;25(3):331–58.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Mehran R, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004;44(7):1393–9.PubMedGoogle Scholar
  17. 17.
    Anderson S, et al. Acute kidney injury in older adults. J Am Soc Nephrol. 2011;22(1):28–38.PubMedCrossRefGoogle Scholar
  18. 18.
    Musso CG, Oreopoulos DG. Aging and physiological changes of the kidneys including changes in glomerular filtration rate. Nephron Physiol. 2011;119 Suppl 1:1–5.CrossRefGoogle Scholar
  19. 19.
    Lerma EV. Anatomic and physiologic changes of the aging kidney. Clin Geriatr Med. 2009;25(3):325–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Weinstein JR, Anderson S. The aging kidney: physiological changes. Adv Chronic Kidney Dis. 2010;17(4):302–7.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Long DA, et al. Blood vessels and the aging kidney. Nephron Exp Nephrol. 2005;101(3):e95–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Coca SG. Acute kidney injury in elderly persons. Am J Kidney Dis. 2010;56(1):122–31.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Grams ME, et al. Albuminuria and estimated glomerular filtration rate independently associate with acute kidney injury. J Am Soc Nephrol. 2010;21(10):1757–64.PubMedCrossRefGoogle Scholar
  24. 24.
    James MT, et al. Glomerular filtration rate, proteinuria, and the incidence and consequences of acute kidney injury: a cohort study. Lancet. 2010;376(9758):2096–103.PubMedCrossRefGoogle Scholar
  25. 25.
    Ishani A, et al. Acute kidney injury increases risk of ESRD among elderly. J Am Soc Nephrol. 2009;20(1):223–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Wald R, et al. Chronic dialysis and death among survivors of acute kidney injury requiring dialysis. JAMA. 2009;302(11):1179–85.PubMedCrossRefGoogle Scholar
  27. 27.
    Bellomo R, et al. Septic acute kidney injury: new concepts. Nephron Exp Nephrol. 2008;109(4):e95–100.PubMedCrossRefGoogle Scholar
  28. 28.
    Bloomfield MG, Sherwin JC, Gkrania-Klotsas E. Risk factors for mortality in Clostridium difficile infection in the general hospital population: a systematic review. J Hosp Infect. 2012;82:1–12.PubMedCrossRefGoogle Scholar
  29. 29.
    Ashraf M, Ostrosky-Zeichner L. Ventilator-associated pneumonia: a review. Hosp Pract (Minneap). 2012;40(1):93–105.CrossRefGoogle Scholar
  30. 30.
    Bagshaw SM, et al. Septic acute kidney injury in critically ill patients: clinical characteristics and outcomes. Clin J Am Soc Nephrol. 2007;2(3):431–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Gurwitz JH, et al. Nonsteroidal anti-inflammatory drug-associated azotemia in the very old. JAMA. 1990;264(4):471–5.PubMedCrossRefGoogle Scholar
  32. 32.
    Kohli HS, et al. Treatment-related acute renal failure in the elderly: a hospital-based prospective study. Nephrol Dial Transplant. 2000;15(2):212–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Rich MW, Crecelius CA. Incidence, risk factors, and clinical course of acute renal insufficiency after cardiac catheterization in patients 70 years of age or older. A prospective study. Arch Intern Med. 1990;150(6):1237–42.PubMedCrossRefGoogle Scholar
  34. 34.
    McGillicuddy EA, et al. Contrast-induced nephropathy in elderly trauma patients. J Trauma. 2009;68(2):294–7.CrossRefGoogle Scholar
  35. 35.
    Kim DY, et al. Is contrast exposure safe among the highest risk trauma patients? J Trauma. 2011;72(1):61–7.Google Scholar
  36. 36.
    Bagshaw SM, Bellomo R, Kellum JA. Oliguria, volume overload, and loop diuretics. Crit Care Med. 2008;36(4 Suppl):S172–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Karajala V, Mansour W, Kellum JA. Diuretics in acute kidney injury. Minerva Anestesiol. 2009;75(5):251–7.PubMedGoogle Scholar
  38. 38.
    Mehta RL. Indications for dialysis in the ICU: renal replacement vs. renal support. Blood Purif. 2001;19(2):227–32.PubMedCrossRefGoogle Scholar
  39. 39.
    Mehta RL. Continuous renal replacement therapy in the critically ill patient. Kidney Int. 2005;67(2):781–95.PubMedCrossRefGoogle Scholar
  40. 40.
    Ricci Z, et al. Practice patterns in the management of acute renal failure in the critically ill patient: an international survey. Nephrol Dial Transplant. 2006;21(3):690–6.PubMedCrossRefGoogle Scholar
  41. 41.
    Palevsky PM, Berns JS, Sheridan AM. Renal replacement therapy (dialysis) in acute kidney injury (acute renal failure) in adults: indications, timing, and dialysis dose. In: Basow D, editor. UpToDate. Waltham; 2012.Google Scholar
  42. 42.
    Schetz M. Non-renal indications for continuous renal replacement therapy. Kidney Int Suppl. 1999;72:S88–94.PubMedCrossRefGoogle Scholar
  43. 43.
    O’Reilly P, Tolwani A. Renal replacement therapy III: IHD, CRRT, SLED. Crit Care Clin. 2005;21(2):367–78.PubMedCrossRefGoogle Scholar
  44. 44.
    Ronco C, et al. Brain density changes during renal replacement in critically ill patients with acute renal failure. Continuous hemofiltration versus intermittent hemodialysis. J Nephrol. 1999;12(3): 173–8.PubMedGoogle Scholar
  45. 45.
    Heering P, et al. The use of different buffers during continuous hemofiltration in critically ill patients with acute renal failure. Intensive Care Med. 1999;25(11):1244–51.PubMedCrossRefGoogle Scholar
  46. 46.
    Palsson R, Laliberte KA, Niles JL. Choice of replacement solution and anticoagulant in continuous venovenous hemofiltration. Clin Nephrol. 2006;65(1):34–42.PubMedCrossRefGoogle Scholar
  47. 47.
    Kellum JA, et al. Continuous versus intermittent renal replacement therapy: a meta-analysis. Intensive Care Med. 2002;28(1):29–37.PubMedCrossRefGoogle Scholar
  48. 48.
    Tonelli M, Manns B, Feller-Kopman D. Acute renal failure in the intensive care unit: a systematic review of the impact of dialytic modality on mortality and renal recovery. Am J Kidney Dis. 2002;40(5):875–85.PubMedCrossRefGoogle Scholar
  49. 49.
    Waldrop J, et al. A comparison of continuous renal replacement therapy to intermittent dialysis in the management of renal insufficiency in the acutely III surgical patient. Am Surg. 2005;71(1):36–9.PubMedGoogle Scholar
  50. 50.
    Uehlinger DE, et al. Comparison of continuous and intermittent renal replacement therapy for acute renal failure. Nephrol Dial Transplant. 2005;20(8):1630–7.PubMedCrossRefGoogle Scholar
  51. 51.
    Gasparovic V, et al. Continuous renal replacement therapy (CRRT) or intermittent hemodialysis (IHD) – what is the procedure of choice in critically ill patients? Ren Fail. 2003;25(5):855–62.PubMedCrossRefGoogle Scholar
  52. 52.
    Schiffl H. Daily haemodialysis for acute renal failure. Curr Opin Nephrol Hypertens. 2002;11(6):589–92.PubMedCrossRefGoogle Scholar
  53. 53.
    Ronco C, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet. 2000;356(9223):26–30.PubMedCrossRefGoogle Scholar
  54. 54.
    Bouman CS, et al. Effects of early high-volume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: a prospective, randomized trial. Crit Care Med. 2002;30(10):2205–11.PubMedCrossRefGoogle Scholar
  55. 55.
    Palevsky PM, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359(1):7–20.PubMedCrossRefGoogle Scholar
  56. 56.
    Oudemans-van Straaten HM, et al. Anticoagulation strategies in continuous renal replacement therapy: can the choice be evidence based? Intensive Care Med. 2006;32(2):188–202.PubMedCrossRefGoogle Scholar
  57. 57.
    Bagshaw SM, et al. Is regional citrate superior to systemic heparin anticoagulation for continuous renal replacement therapy? A prospective observational study in an adult regional critical care system. J Crit Care. 2005;20(2):155–61.PubMedCrossRefGoogle Scholar
  58. 58.
    Brophy PD, et al. Multi-centre evaluation of anticoagulation in patients receiving continuous renal replacement therapy (CRRT). Nephrol Dial Transplant. 2005;20(7):1416–21.PubMedCrossRefGoogle Scholar
  59. 59.
    Tolwani AJ, et al. Simplified citrate anticoagulation for continuous renal replacement therapy. Kidney Int. 2001;60(1):370–4.PubMedCrossRefGoogle Scholar
  60. 60.
    Kellum JA, et al. The first international consensus conference on continuous renal replacement therapy. Kidney Int. 2002;62(5):1855–63.PubMedCrossRefGoogle Scholar
  61. 61.
    Kellum JA, et al. Consensus development in acute renal failure: the acute dialysis quality initiative. Curr Opin Crit Care. 2005;11(6): 527–32.PubMedCrossRefGoogle Scholar
  62. 62.
    Ronco C. Recent evolution of renal replacement therapy in the critically ill patient. Crit Care. 2006;10(1):123.PubMedCrossRefGoogle Scholar
  63. 63.
    Ronco C, et al. Interpreting the mechanisms of continuous renal replacement therapy in sepsis: the peak concentration hypothesis. Artif Organs. 2003;27(9):792–801.PubMedCrossRefGoogle Scholar
  64. 64.
    Joannidis M, et al. Prevention of acute kidney injury and protection of renal function in the intensive care unit. Expert opinion of the Working Group for Nephrology, ESICM. Intensive Care Med. 2010;36(3):392–411.PubMedCrossRefGoogle Scholar
  65. 65.
    Schmitt R, et al. Recovery of kidney function after acute kidney injury in the elderly: a systematic review and meta-analysis. Am J Kidney Dis. 2008;52(2):262–71.PubMedCrossRefGoogle Scholar
  66. 66.
    Del Vecchio L, Locatelli F. Ethical issues in the elderly with renal disease. Clin Geriatr Med. 2009;25(3):543–53.PubMedCrossRefGoogle Scholar
  67. 67.
    Cohen LM, et al. Renal palliative care. J Palliat Med. 2006;9(4):977–92.PubMedCrossRefGoogle Scholar
  68. 68.
    Claure-Del Granado R, Mehta RL. Withholding and withdrawing renal support in acute kidney injury. Semin Dial. 2011;24(2): 208–14.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of SurgeryBrigham and Women’s HospitalBostonUSA
  2. 2.Trauma Burn and Surgical Critical CareBrigham and Women’s HospitalBostonUSA

Personalised recommendations