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
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