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Renal replacement therapy in acute kidney injury: controversy and consensus

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Abstract

Renal replacement therapies (RRTs) represent a cornerstone in the management of severe acute kidney injury. This area of intensive care and nephrology has undergone significant improvement and evolution in recent years. Continuous RRTs have been a major focus of new technological and treatment strategies. RRT is being used increasingly in the intensive care unit, not only for renal indications but also for other organ-supportive strategies. Several aspects related to RRT are now well established, but others remain controversial. In this review, we review the available RRT modalities, covering technical and clinical aspects. We discuss several controversial issues, provide some practical recommendations, and where possible suggest a research agenda for the future.

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Abbreviations

AKI:

Acute kidney injury

ARDS:

Acute respiratory distress syndrome

ATN:

Acute Renal Failure Trial Network

BBB:

Blood–brain barrier

BUN:

Blood urea nitrogen

CARRESS:

Effectiveness of Ultrafiltration in Treating People With Acute Decompensated Heart Failure and Cardiorenal Syndrome

CPFA:

Couple plasma filtration and adsorption

CRRT:

Continuous renal replacement therapy

CVVH:

Continuous veno-venous hemofiltration

FF:

Filtration fraction

HCO:

High cutoff

HF:

Hemofiltration

HIT:

Heparin-induced thrombocytopenia

ICP:

Intracranial pressure

ICU:

Intensive care unit

IHD:

Intermittent hemodialysis

LMWH:

Low-molecular-weight heparin

NGAL:

Neutrophil gelatinase-associated lipocalin

POC:

Point-of-care

Qb:

Blood flow rate

RCA:

Regional citrate anticoagulation

RCT:

Randomized controlled trial

RRT:

Renal replacement therapy

SLED:

Sustained low-efficiency dialysis

UFH:

Unfractionated heparin

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Authors and Affiliations

  1. Department Nephrology Dialysis & Transplantation, International Renal Research Institute (IRRIV), San Bortolo Hospital, Viale Rodolfi, 36100, Vicenza, Italy

    Claudio Ronco

  2. Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy

    Zaccaria Ricci

  3. Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium

    Daniel De Backer, Fabio S Taccone & Jean-Louis Vincent

  4. Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15261, USA

    John A Kellum

  5. Division of Emergency and Intensive Care Medicine, Department of Internal Medicine, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria

    Michael Joannidis

  6. Department of Intensive Care Medicine, Radboud University Medical Centre, PO Box 9101, 6500, HB, Nijmegen, The Netherlands

    Peter Pickkers

  7. Nephrology, Dialysis and Kidney Transplantation Unit, University of Torino, Azienda Ospedaliera Universitaria ‘Città della Salute e della Scienza di Torino Presidio Molinette’, Corso Bramante 88, 10126, Turin, Italy

    Vincenzo Cantaluppi

  8. Department of Intensive Care, Aurelia Hospital and European Hospital, Via Portuense 694, 00416, Rome, Italy

    Franco Turani

  9. Service of Nephrology, Department of Internal Medicine Specialties, University Hospital of Geneva, 4 rue Gabrielle Perret-Gentil, CH 1211, Geneva, Switzerland

    Patrick Saudan

  10. Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia

    Rinaldo Bellomo

  11. Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d’Anesthésie-Réanimation 2, Avenue de Magellan, F-33600, Pessac, France

    Olivier Joannes-Boyau

  12. Università Cattolica del Sacro Cuore - Policlinico Universitario A. Gemelli, Largo Agostino Gemelli 8, 00168, Rome, Italy

    Massimo Antonelli

  13. Department of Anesthesiology and Critical Care, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, 7 Denis Diderot, 75475, Paris, Cedex 10, France

    Didier Payen

  14. Adult Critical Care Unit, The Royal London Hospital, Barts Health, Whitechapel Road, London, E1 1BB, UK

    John R Prowle

Authors
  1. Claudio Ronco
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  2. Zaccaria Ricci
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  3. Daniel De Backer
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  4. John A Kellum
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  5. Fabio S Taccone
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  6. Michael Joannidis
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  7. Peter Pickkers
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  8. Vincenzo Cantaluppi
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  9. Franco Turani
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  11. Rinaldo Bellomo
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  12. Olivier Joannes-Boyau
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  13. Massimo Antonelli
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  14. Didier Payen
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  15. John R Prowle
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  16. Jean-Louis Vincent
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Corresponding author

Correspondence to Zaccaria Ricci.

Additional information

Competing interests

DDB is a member of the Baxter-Gambro European Medical Advisory Board. JAK has received research funding and consulting fees from Gambro (a brand of Baxter, Deerfield, IL, USA) and Fresenius (Bad Homburg, Germany). MJ has received speaker or consulting fees from Frenenius and Gambro. FT has received honoraria from Bellco (North Amityville, NY, USA) for lectures. The other authors declare that they have no competing interests.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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Ronco, C., Ricci, Z., De Backer, D. et al. Renal replacement therapy in acute kidney injury: controversy and consensus. Crit Care 19, 146 (2015). https://doi.org/10.1186/s13054-015-0850-8

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