Procedures in Critical Care: Dialysis and Apheresis

  • Matthew J. Diamond
  • Harold M. Szerlip


Acute renal injury in the intensive care unit (ICU) is associated with significant excess mortality. A rise in the serum creatinine of 0.3 mg/dl is associated with worse outcomes in critically ill patients.1,2 Using the consensus definition of acute renal injury, the so-called RIFLE criteria 3, 4 (Fig. 8-1), the odds ratio for death increases from approximately 2.5 in those patients classified as having renal Risk to 5 for renal Injury and finally to 10 for those with Failure.5 Even after adjusting for other comorbidities, renal injury in the ICU is an independent risk factor for death 6 – 8 and the need for acute dialytic therapy in the ICU is associated with 50–60% mortality. 9, 10


Peritoneal Dialysis Renal Replacement Therapy Continuous Renal Replacement Therapy Blood Flow Rate Replacement Fluid 
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  1. 1.
    Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16(11):3365–3370.PubMedCrossRefGoogle Scholar
  2. 2.
    Lassnigg A, Schmidlin D, Mouhieddine M, et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol. 2004;15(6):1597–1605.PubMedCrossRefGoogle Scholar
  3. 3.
    Bellomo R, Ronco C, Kellum JA, 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–R212.PubMedCrossRefGoogle Scholar
  4. 4.
    Mehta RL et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31.PubMedCrossRefGoogle Scholar
  5. 5.
    Uchino S et al. An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med. 2006;34(7):1913–1917.PubMedCrossRefGoogle Scholar
  6. 6.
    Barrantes F et al. Acute kidney injury criteria predict outcomes of critically ill patients. Crit Care Med. 2008;36(5):1397–1403.PubMedCrossRefGoogle Scholar
  7. 7.
    Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality in acute kidney injury: a systematic review. Kidney Int. 2008;73(5):538–546.PubMedCrossRefGoogle Scholar
  8. 8.
    Bagshaw SM et al. A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients. Nephrol Dial Transplant. 2008;23(4):1203–1210.PubMedCrossRefGoogle Scholar
  9. 9.
    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
  10. 10.
    Uchino S et al. Acute renal failure in critically ill patients: a multinational, multicenter study. Jama. 2005;294(7):813–818.PubMedCrossRefGoogle Scholar
  11. 11.
    Liu KD et al. Timing of initiation of dialysis in critically ill patients with acute kidney injury. Clin J Am Soc Nephrol. 2006;1(5):915–919.PubMedCrossRefGoogle Scholar
  12. 12.
    Seabra VF et al. Timing of renal replacement therapy initiation in acute renal failure: a meta-analysis. Am J Kidney Dis. 2008;52(2):272–284.PubMedCrossRefGoogle Scholar
  13. 13.
    Phu NH et al. Hemofiltration and peritoneal dialysis in infection-associated acute renal failure in Vietnam. N Engl J Med. 2002;347(12):895–902.PubMedCrossRefGoogle Scholar
  14. 14.
    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;108:S87–S93.PubMedCrossRefGoogle Scholar
  15. 15.
    Kramer P et al. Elimination of cardiac glycosides through hemofiltration. J Dial. 1977;1(7):689–695.PubMedGoogle Scholar
  16. 16.
    Kramer P et al. Continuous arteriovenous haemofiltration. A new kidney replacement therapy. Proc Eur Dial Transplant Assoc. 1981;18:743–749.PubMedGoogle Scholar
  17. 17.
    Cho KC et al. Survival by dialysis modality in critically ill patients with acute kidney injury. J Am Soc Nephrol. 2006;17(11):3132–3138.PubMedCrossRefGoogle Scholar
  18. 18.
    Uehlinger DE et al. Comparison of continuous and intermittent renal replacement therapy for acute renal failure. Nephrol Dial Transplant. 2005;20(8):1630–1637.PubMedCrossRefGoogle Scholar
  19. 19.
    Vinsonneau C et al. Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial. Lancet. 2006;368(9533):379–385.PubMedCrossRefGoogle Scholar
  20. 20.
    Schiffl H, Lang SM, Fischer R. Daily hemodialysis and the outcome of acute renal failure. N Engl J Med. 2002;346(5):305–310.PubMedCrossRefGoogle Scholar
  21. 21.
    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
  22. 22.
    Schwab SJ et al. Hemodialysis without anticoagulation. One-year prospective trial in hospitalized patients at risk for bleeding. Am J Med. 1987;83(3):405–410.PubMedCrossRefGoogle Scholar
  23. 23.
    Tobe SW et al. A novel regional citrate anticoagulation protocol for CRRT using only commercially available solutions. J Crit Care. 2003;18(2):121–129.PubMedCrossRefGoogle Scholar
  24. 24.
    Tolwani AJ et al. A practical citrate anticoagulation continuous venovenous hemodiafiltration protocol for metabolic control and high solute clearance. Clin J Am Soc Nephrol. 2006;1(1):79–87.PubMedCrossRefGoogle Scholar
  25. 25.
    Goldfrank LR. Goldfrank’s toxicologic emergencies. 7th ed. New York: McGraw-Hill Medical Pub. Division; 2002:58–68.Google Scholar
  26. 26.
    Madore F. Plasmapheresis. Technical aspects and indications. Crit Care Clin. 2002;18(2):375–392.PubMedCrossRefGoogle Scholar
  27. 27.
    Rahman T, Harper L. Plasmapheresis in nephrology: an update. Curr Opin Nephrol Hypertens. 2006;15(6):603–609.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Hypertension and Transplant Medicine, Section of NephrologyMedical College of GeorgiaAugustaUSA

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