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Dialytic Therapy of Acute Kidney Injury

  • Alian A. Al-balas
  • Keith M. Wille
  • Ashita J. Tolwani
Chapter

Abstract

The management of patients with severe acute kidney injury (AKI) is largely supportive and includes renal replacement therapy (RRT). Available RRT modalities are intermittent hemodialysis (IHD); continuous renal replacement therapy (CRRT); hybrid therapies, known as prolonged intermittent renal replacement therapy (PIRRT); and peritoneal dialysis (PD). This chapter briefly reviews these dialytic options and the current evidence regarding the timing of RRT initiation, modality selection, and the practical considerations of the RRT prescription for AKI.

Keywords

Acute kidney Injury (AKI) Renal replacement therapy (RRT) Continuous renal replacement therapy (CRRT) Hemodialysis Prolonged intermittent renal replacement therapy (PIRRT) Hemofiltration Sustained low-efficiency dialysis (SLED) 

References

  1. 1.
    Karvellas CJ, Farhat MR, Sajjad I, et al. A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis. Crit Care. 2011;15:R72.CrossRefGoogle Scholar
  2. 2.
    Seabra VF, Balk EM, Liangos O, Sosa MA, Cendoroglo M, Jaber BL. Timing of renal replacement therapy initiation in acute renal failure: a meta-analysis. Am J Kidney Dis. 2008;52:272–84.CrossRefGoogle Scholar
  3. 3.
    Zarbock A, Kellum JA, Schmidt C, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury: the ELAIN randomized clinical trial. JAMA. 2016;315:2190–9.CrossRefGoogle Scholar
  4. 4.
    Gaudry S, Hajage D, Schortgen F, et al. Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med. 2016;375:122–33.CrossRefGoogle Scholar
  5. 5.
    Selby NM, McIntyre CW. A systematic review of the clinical effects of reducing dialysate fluid temperature. Nephrol Dial Transplant. 2006;21:1883–98.CrossRefGoogle Scholar
  6. 6.
    Palevsky PM, O'Connor TZ, Chertow GM, et al. Intensity of renal replacement therapy in acute kidney injury: perspective from within the Acute Renal Failure Trial Network Study. Crit Care. 2009;13:310.CrossRefGoogle Scholar
  7. 7.
    Emili S, Black NA, Paul RV, Rexing CJ, Ullian ME. A protocol-based treatment for intradialytic hypotension in hospitalized hemodialysis patients. Am J Kidney Dis. 1999;33:1107–14.CrossRefGoogle Scholar
  8. 8.
    Conger J. Dialysis and related therapies. Semin Nephrol. 1998;18:533–40.PubMedGoogle Scholar
  9. 9.
    Briglia A, Paganini EP. Acute renal failure in the intensive care unit. Therapy overview, patient risk stratification, complications of renal replacement, and special circumstances. Clin Chest Med. 1999;20:347–66, viiiCrossRefGoogle Scholar
  10. 10.
    Paganini EP, Sandy D, Moreno L, Kozlowski L, Sakai K. The effect of sodium and ultrafiltration modelling on plasma volume changes and haemodynamic stability in intensive care patients receiving haemodialysis for acute renal failure: a prospective, stratified, randomized, cross-over study. Nephrol Dial Transplant. 1996;11(Suppl 8):32–7.CrossRefGoogle Scholar
  11. 11.
    Davenport A, Finn R, Goldsmith HJ. Management of patients with renal failure complicated by cerebral oedema. Blood Purif. 1989;7:203–9.CrossRefGoogle Scholar
  12. 12.
    Cerda J, Ronco C. Modalities of continuous renal replacement therapy: technical and clinical considerations. Semin Dial. 2009;22:114–22.CrossRefGoogle Scholar
  13. 13.
    Ronco C, Bellomo R. Basic mechanisms and definitions for continuous renal replacement therapies. Int J Artif Organs. 1996;19:95–9.CrossRefGoogle Scholar
  14. 14.
    Ronco C, Ricci Z. Renal replacement therapies: physiological review. Intensive Care Med. 2008;34:2139–46.CrossRefGoogle Scholar
  15. 15.
    Clark WR, Turk JE, Kraus MA, Gao D. Dose determinants in continuous renal replacement therapy. Artif Organs. 2003;27:815–20.CrossRefGoogle Scholar
  16. 16.
    Brunet S, Leblanc M, Geadah D, Parent D, Courteau S, Cardinal J. Diffusive and convective solute clearances during continuous renal replacement therapy at various dialysate and ultrafiltration flow rates. Am J Kidney Dis. 1999;34:486–92.CrossRefGoogle Scholar
  17. 17.
    Friedrich JO, Wald R, Bagshaw SM, Burns KE, Adhikari NK. Hemofiltration compared to hemodialysis for acute kidney injury: systematic review and meta-analysis. Crit Care. 2012;16:R146.CrossRefGoogle Scholar
  18. 18.
    De Vriese AS, Colardyn FA, Philippe JJ, Vanholder RC, De Sutter JH, Lameire NH. Cytokine removal during continuous hemofiltration in septic patients. J Am Soc Nephrol. 1999;10:846–53.PubMedGoogle Scholar
  19. 19.
    Farese S, Jakob SM, Kalicki R, Frey FJ, Uehlinger DE. Treatment of acute renal failure in the intensive care unit: lower costs by intermittent dialysis than continuous venovenous hemodiafiltration. Artif Organs. 2009;33:634–40.CrossRefGoogle Scholar
  20. 20.
    Heering P, Morgera S, Schmitz FJ, et al. Cytokine removal and cardiovascular hemodynamics in septic patients with continuous venovenous hemofiltration. Intensive Care Med. 1997;23:288–96.CrossRefGoogle Scholar
  21. 21.
    Hoffmann JN, Hartl WH, Deppisch R, Faist E, Jochum M, Inthorn D. Effect of hemofiltration on hemodynamics and systemic concentrations of anaphylatoxins and cytokines in human sepsis. Intensive Care Med. 1996;22:1360–7.CrossRefGoogle Scholar
  22. 22.
    Morgera S, Slowinski T, Melzer C, et al. Renal replacement therapy with high-cutoff hemofilters: Impact of convection and diffusion on cytokine clearances and protein status. Am J Kidney Dis. 2004;43:444–53.CrossRefGoogle Scholar
  23. 23.
    van Deuren M, van der Meer JW. Hemofiltration in septic patients is not able to alter the plasma concentration of cytokines therapeutically. Intensive Care Med. 2000;26:1176–8.CrossRefGoogle Scholar
  24. 24.
    Clark E, Molnar AO, Joannes-Boyau O, Honore PM, Sikora L, Bagshaw SM. High-volume hemofiltration for septic acute kidney injury: a systematic review and meta-analysis. Crit Care. 2014;18:R7.CrossRefGoogle Scholar
  25. 25.
    Combes A, Brechot N, Amour J, et al. Early high-volume hemofiltration versus standard care for post-cardiac surgery shock. The HEROICS Study. Am J Respir Crit Care Med. 2015;192:1179–90.CrossRefGoogle Scholar
  26. 26.
    Fieghen HE, Friedrich JO, Burns KE, et al. The hemodynamic tolerability and feasibility of sustained low efficiency dialysis in the management of critically ill patients with acute kidney injury. BMC Nephrol. 2010;11:32.CrossRefGoogle Scholar
  27. 27.
    Kumar VA, Yeun JY, Depner TA, Don BR. Extended daily dialysis vs. continuous hemodialysis for ICU patients with acute renal failure: a two-year single center report. Int J Artif Organs. 2004;27:371–9.CrossRefGoogle Scholar
  28. 28.
    Kielstein JT, Kretschmer U, Ernst T, et al. Efficacy and cardiovascular tolerability of extended dialysis in critically ill patients: a randomized controlled study. Am J Kidney Dis. 2004;43:342–9.CrossRefGoogle Scholar
  29. 29.
    Wu VC, Wang CH, Wang WJ, et al. Sustained low-efficiency dialysis versus continuous veno-venous hemofiltration for postsurgical acute renal failure. Am J Surg. 2010;199:466–76.CrossRefGoogle Scholar
  30. 30.
    Steiner RW. Continuous equilibration peritoneal dialysis in acute renal failure. Perit Dial Int. 1989;9:5–7.PubMedGoogle Scholar
  31. 31.
    Phu NH, Hien TT, Mai NT, et al. Hemofiltration and peritoneal dialysis in infection-associated acute renal failure in Vietnam. N Engl J Med. 2002;347:895–902.CrossRefGoogle Scholar
  32. 32.
    Rabindranath K, Adams J, Macleod AM, Muirhead N. Intermittent versus continuous renal replacement therapy for acute renal failure in adults. Cochrane Database Syst Rev. 2007:CD003773.Google Scholar
  33. 33.
    Bouchard J, Soroko SB, Chertow GM, et al. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int. 2009;76:422–7.CrossRefGoogle Scholar
  34. 34.
    Bagshaw SM, Berthiaume LR, Delaney A, Bellomo R. Continuous versus intermittent renal replacement therapy for critically ill patients with acute kidney injury: a meta-analysis. Crit Care Med. 2008;36:610–7.CrossRefGoogle Scholar
  35. 35.
    Pannu N, Klarenbach S, Wiebe N, Manns B, Tonelli M. Renal replacement therapy in patients with acute renal failure: a systematic review. JAMA. 2008;299:793–805.CrossRefGoogle Scholar
  36. 36.
    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;40:875–85.CrossRefGoogle Scholar
  37. 37.
    Kellum JA, Angus DC, Johnson JP, et al. Continuous versus intermittent renal replacement therapy: a meta-analysis. Intensive Care Med. 2002;28:29–37.CrossRefGoogle Scholar
  38. 38.
    Schneider AG, Bellomo R, Bagshaw SM, et al. Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury: a systematic review and meta-analysis. Intensive Care Med. 2013;39:987–97.CrossRefGoogle Scholar
  39. 39.
    Baldwin I, Bellomo R, Naka T, Koch B, Fealy N. A pilot randomized controlled comparison of extended daily dialysis with filtration and continuous veno-venous hemofiltration: fluid removal and hemodynamics. Int J Artif Organs. 2007;30:1083–9.CrossRefGoogle Scholar
  40. 40.
    Baldwin I, Naka T, Koch B, Fealy N, Bellomo R. A pilot randomised controlled comparison of continuous veno-venous haemofiltration and extended daily dialysis with filtration: effect on small solutes and acid-base balance. Intensive Care Med. 2007;33(5):830.CrossRefGoogle Scholar
  41. 41.
    Zhang L, Yang J, Eastwood GM, Zhu G, Tanaka A, Bellomo R. Extended daily dialysis versus continuous renal replacement therapy for acute kidney injury: a meta-analysis. Am J Kidney Dis. 2015;66:322–30.CrossRefGoogle Scholar
  42. 42.
    Gabriel DP, Caramori JT, Martim LC, Barretti P, Balbi AL. High volume peritoneal dialysis vs daily hemodialysis: a randomized, controlled trial in patients with acute kidney injury. Kidney Int Suppl. 2008:S87–93.Google Scholar
  43. 43.
    Ponce D, Berbel MN, Abrao JM, Goes CR, Balbi AL. A randomized clinical trial of high volume peritoneal dialysis versus extended daily hemodialysis for acute kidney injury patients. Int Urol Nephrol. 2013;45:869–78.CrossRefGoogle Scholar
  44. 44.
    Chionh CY, Soni SS, Finkelstein FO, Ronco C, Cruz DN. Use of peritoneal dialysis in AKI: a systematic review. Clin J Am Soc Nephrol. 2013;8:1649–60.CrossRefGoogle Scholar
  45. 45.
    Davenport A. Renal replacement therapy in the patient with acute brain injury. Am J Kidney Dis. 2001;37:457–66.CrossRefGoogle Scholar
  46. 46.
    Davenport A. Continuous renal replacement therapies in patients with acute neurological injury. Semin Dial. 2009;22:165–8.CrossRefGoogle Scholar
  47. 47.
    Lin CM, Lin JW, Tsai JT, et al. Intracranial pressure fluctuation during hemodialysis in renal failure patients with intracranial hemorrhage. Acta Neurochir Suppl. 2008;101:141–4.CrossRefGoogle Scholar
  48. 48.
    Davenport A. Continuous renal replacement therapies in patients with liver disease. Semin Dial. 2009;22:169–72.CrossRefGoogle Scholar
  49. 49.
    Hirsh J, Warkentin TE, Shaughnessy SG, et al. Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. Chest. 2001;119:64S–94S.CrossRefGoogle Scholar
  50. 50.
    Davenport A, Will EJ, Davison AM. Comparison of the use of standard heparin and prostacyclin anticoagulation in spontaneous and pump-driven extracorporeal circuits in patients with combined acute renal and hepatic failure. Nephron. 1994;66:431–7.CrossRefGoogle Scholar
  51. 51.
    Martin PY, Chevrolet JC, Suter P, Favre H. Anticoagulation in patients treated by continuous venovenous hemofiltration: a retrospective study. Am J Kidney Dis. 1994;24:806–12.CrossRefGoogle Scholar
  52. 52.
    van de Wetering J, Westendorp RG, van der Hoeven JG, Stolk B, Feuth JD, Chang PC. Heparin use in continuous renal replacement procedures: the struggle between filter coagulation and patient hemorrhage. J Am Soc Nephrol. 1996;7:145–50.PubMedGoogle Scholar
  53. 53.
    Tolwani AJ, Prendergast MB, Speer RR, Stofan BS, Wille KM. A practical citrate anticoagulation continuous venovenous hemodiafiltration protocol for metabolic control and high solute clearance. Clin J Am Soc Nephrol. 2006;1:79–87.CrossRefGoogle Scholar
  54. 54.
    Morgera S. Regional anticoagulation with citrate: expanding its indications. Crit Care Med. 2011;39:399–400.CrossRefGoogle Scholar
  55. 55.
    Oudemans-van Straaten HM, Kellum JA, Bellomo R. Clinical review: anticoagulation for continuous renal replacement therapy--heparin or citrate? Crit Care. 2011;15:202.CrossRefGoogle Scholar
  56. 56.
    Bagshaw SM, Laupland KB, Boiteau PJ, Godinez-Luna T. 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;20:155–61.CrossRefGoogle Scholar
  57. 57.
    Hofmann RM, Maloney C, Ward DM, Becker BN. A novel method for regional citrate anticoagulation in continuous venovenous hemofiltration (CVVHF). Ren Fail. 2002;24:325–35.CrossRefGoogle Scholar
  58. 58.
    Cointault O, Kamar N, Bories P, et al. Regional citrate anticoagulation in continuous venovenous haemodiafiltration using commercial solutions. Nephrol Dial Transplant. 2004;19:171–8.CrossRefGoogle Scholar
  59. 59.
    Bihorac A, Ross EA. Continuous venovenous hemofiltration with citrate-based replacement fluid: efficacy, safety, and impact on nutrition. Am J Kidney Dis. 2005;46:908–18.CrossRefGoogle Scholar
  60. 60.
    Kutsogiannis DJ, Mayers I, Chin WD, Gibney RT. Regional citrate anticoagulation in continuous venovenous hemodiafiltration. Am J Kidney Dis. 2000;35:802–11.CrossRefGoogle Scholar
  61. 61.
    Mehta RL, McDonald BR, Aguilar MM, Ward DM. Regional citrate anticoagulation for continuous arteriovenous hemodialysis in critically ill patients. Kidney Int. 1990;38:976–81.CrossRefGoogle Scholar
  62. 62.
    Monchi M, Berghmans D, Ledoux D, Canivet JL, Dubois B, Damas P. Citrate vs. heparin for anticoagulation in continuous venovenous hemofiltration: a prospective randomized study. Intensive Care Med. 2004;30:260–5.CrossRefGoogle Scholar
  63. 63.
    Palsson R, Niles JL. Regional citrate anticoagulation in continuous venovenous hemofiltration in critically ill patients with a high risk of bleeding. Kidney Int. 1999;55:1991–7.CrossRefGoogle Scholar
  64. 64.
    Swartz R, Pasko D, O'Toole J, Starmann B. Improving the delivery of continuous renal replacement therapy using regional citrate anticoagulation. Clin Nephrol. 2004;61:134–43.CrossRefGoogle Scholar
  65. 65.
    Tobe SW, Aujla P, Walele AA, et al. A novel regional citrate anticoagulation protocol for CRRT using only commercially available solutions. J Crit Care. 2003;18:121–9.CrossRefGoogle Scholar
  66. 66.
    Tolwani AJ, Campbell RC, Schenk MB, Allon M, Warnock DG. Simplified citrate anticoagulation for continuous renal replacement therapy. Kidney Int. 2001;60:370–4.CrossRefGoogle Scholar
  67. 67.
    Calatzis A, Toepfer M, Schramm W, Spannagl M, Schiffl H. Citrate anticoagulation for extracorporeal circuits: effects on whole blood coagulation activation and clot formation. Nephron. 2001;89:233–6.CrossRefGoogle Scholar
  68. 68.
    Pinnick RV, Wiegmann TB, Diederich DA. Regional citrate anticoagulation for hemodialysis in the patient at high risk for bleeding. N Engl J Med. 1983;308:258–61.CrossRefGoogle Scholar
  69. 69.
    Apsner R, Schwarzenhofer M, Derfler K, Zauner C, Ratheiser K, Kranz A. Impairment of citrate metabolism in acute hepatic failure. Wien Klin Wochenschr. 1997;109:123–7.PubMedGoogle Scholar
  70. 70.
    Kramer L, Bauer E, Joukhadar C, et al. Citrate pharmacokinetics and metabolism in cirrhotic and noncirrhotic critically ill patients. Crit Care Med. 2003;31:2450–5.CrossRefGoogle Scholar
  71. 71.
    Meier-Kriesche HU, Gitomer J, Finkel K, DuBose T. Increased total to ionized calcium ratio during continuous venovenous hemodialysis with regional citrate anticoagulation. Crit Care Med. 2001;29:748–52.CrossRefGoogle Scholar
  72. 72.
    Bakker AJ, Boerma EC, Keidel H, Kingma P, van der Voort PH. Detection of citrate overdose in critically ill patients on citrate-anticoagulated venovenous haemofiltration: use of ionised and total/ionised calcium. Clin Chem Lab Med. 2006;44:962–6.CrossRefGoogle Scholar
  73. 73.
    Bai M, Zhou M, He L, et al. Citrate versus heparin anticoagulation for continuous renal replacement therapy: an updated meta-analysis of RCTs. Intensive Care Med. 2015;41:2098–110.CrossRefGoogle Scholar
  74. 74.
    Clark WR, Ronco C. Renal replacement therapy in acute renal failure: solute removal mechanisms and dose quantification. Kidney Int Suppl. 1998;66:S133–7.PubMedGoogle Scholar
  75. 75.
    Clark WR, Ronco C. CRRT efficiency and efficacy in relation to solute size. Kidney Int Suppl. 1999:S3–7.Google Scholar
  76. 76.
    Troyanov S, Cardinal J, Geadah D, et al. Solute clearances during continuous venovenous haemofiltration at various ultrafiltration flow rates using Multiflow-100 and HF1000 filters. Nephrol Dial Transplant. 2003;18:961–6.CrossRefGoogle Scholar
  77. 77.
    Ronco C, Bellomo R, Homel P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet. 2000;356:26–30.CrossRefGoogle Scholar
  78. 78.
    Schiffl H, Lang SM, Fischer R. Daily hemodialysis and the outcome of acute renal failure. N Engl J Med. 2002;346:305–10.CrossRefGoogle Scholar
  79. 79.
    Saudan P, Niederberger M, De Seigneux S, et al. Adding a dialysis dose to continuous hemofiltration increases survival in patients with acute renal failure. Kidney Int. 2006;70(7):1312.CrossRefGoogle Scholar
  80. 80.
    Palevsky PM, Zhang JH, O’Connor TZ, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359:7–20.CrossRefGoogle Scholar
  81. 81.
    Investigators RRTS, Bellomo R, Cass A, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med. 2009;361:1627–38.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Alian A. Al-balas
    • 1
  • Keith M. Wille
    • 2
  • Ashita J. Tolwani
    • 1
  1. 1.Division of NephrologyUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Division of Pulmonary, Allergy, and Critical Care MedicineUniversity of Alabama at BirminghamBirminghamUSA

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