Renal Replacement Therapy in the Critically Ill Surgical Patient
The diagnosis of clinically significant acute kidney injury (AKI) among the critically ill surgical population occurs in approximately one in four admissions . About 5 % of all patients admitted to the intensive care unit (ICU), or 1 out of every 20 admissions, require some form of renal replacement therapy (RRT) . Among all critically ill patients who require RRT, the mortality has consistently been around 60 % . Practically speaking, RRT refers to the clearance of excessive electrolytes, toxic solutes, and volume that accumulates in the intravascular and extravascular space in the setting of AKI. Most often, this type of therapy is delivered via a venovenous extracorporeal circuit with a blood pump that drives venous blood through an artificial “kidney” membrane. Less commonly, the peritoneal cavity could be used to exchange electrolytes and solutes in the form of peritoneal dialysis. We will focus our discussion in this chapter mainly on extracorporeal RRT with only a brief section on peritoneal dialysis.
KeywordsRenal replacement therapy Hemofiltration Hemodialysis Continuous Acute kidney injury Surgical critical care
- 11.Palevsky PM, Zhang JH, O’Connor TZ, et al. for the VA/NIH Acute Renal Failure Trial Network. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359:7–20.Google Scholar
- 24.Bouman CS, Oudemans-Van Straaten HM, Tijssen JG, 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;30:2205–11.CrossRefGoogle Scholar
- 26.Barbar SD, Binquet C, Monchi M, et al. Impact on mortality of the timing of renal replacement therapy in patients with severe acute kidney injury in septic shock: the IDEAL-ICU study (initiation of dialysis early versus delayed in the intensive care unit): study protocol for a randomized controlled trial. Trials. 2014;15:270.CrossRefGoogle Scholar
- 49.Bai ZG, Yang K, Tian J, et al. Bicarbonate versus lactate solutions for acute peritoneal dialysis. Cochrane Database Syst Rev. 2010;9:CD007034.Google Scholar
Open Access This chapter is licensed under the terms of the Creative Commons Attribution-NonCommercial 2.5 International License (http://creativecommons.org/licenses/by-nc/2.5/), which permits any noncommercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.
The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.