Acute Renal Replacement Therapy

Chapter

Abstract

The decision when to initiate replacement therapy (RRT) in patients with acute kidney injury (AKI) is extremely variable and tends to be based on empiricism, depending upon the immediate and projected trajectory of the clinical situation, clinician experience and local institutional practices and resources. For example, RRT is typically initiated for oliguria, acidosis and correction of volume overload in the intensive care unit (ICU), whereas in the renal ward azotaemia and hyperkalaemia are more common triggers to initiate RRT.

Keywords

Convection Lactate Arsenic Citrate Bicarbonate 

References

  1. 1.
    Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative workgroup. 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:R204–12.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Molitoris BA, Levin A, Warnock DG, Joannidis M, Mehta RL, Kellum JA, Ronco C, Shah S, Acute Kidney Injury Network. Improving outcomes from acute kidney injury. J Am Soc Nephrol. 2007;18:1992–4.PubMedCrossRefGoogle Scholar
  3. 3.
    Hoste EA, Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, Kellum JA. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care. 2006;10:R73.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Kielstein J, Kretschmer U, Ernst T, Hafer C, Bahr M, Haller H, Fliser D. Efficacy and cardiovascular tolerability of extended daily dialysis in critically ill patients: a randomized controlled study. Am J Kidney Dis. 2004;43:342–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Vinsonneau DCC, Combes A, Costa de Beauregard MA, Klouche K, Boulain T, Pallot JL, Chiche JD, Taupin P, Landais P, Dhainaut JF. A prospective, multicentre, randomized clinical trial comparing continuous venovenous hemodiafiltration to intermittent hemodialysis for the treatment of acute renal failure in intensive care unit patients with multiple organ dysfunction syndrome. Lancet. 2006;368:379–85.PubMedCrossRefGoogle Scholar
  6. 6.
    Augustine JJ, Sandy D, Seifert TH, Paganini EP. A randomized controlled trial comparing intermittent with continuous dialysis in patients with ARF. Am J Kidney Dis. 2004;44:1000–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Davenport A. Can advances in hemodialysis machine technology prevent intradialytic hypotension? Semin Dial. 2009;22:231–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Phu NH, Hien TT, Mai NT, Chau TT, Chuong LV, Loc PP, Winearls C, Farrar J, White N, Day N. Haemofiltration and peritoneal dialysis in infection-associated acute renal failure in Vietnam. N Engl J Med. 2002;347:895–902.PubMedCrossRefGoogle Scholar
  9. 9.
    Gabriel DP, Nascimento GV, Caramori JT, Martim LC, Barretti P, Balbi AL. High volume peritoneal dialysis for acute renal failure. Perit Dial Int. 2007;27:277–82.PubMedGoogle Scholar
  10. 10.
    Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, La Greca G. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet. 2000;356:26–30.PubMedCrossRefGoogle Scholar
  11. 11.
    VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, O’Connor TZ, Chertow GM, Crowley ST, Choudhury D, Finkel K, Kellum JA, Paganini E, Schein RM, Smith MW, Swanson KM, Thompson BT, Vijayan A, Watnick S, Star RA, Peduzzi P. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359:7–20.PubMedCrossRefGoogle Scholar
  12. 12.
    RENAL Replacement Therapy Study Investigators, Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lo S, McArthur C, McGuinness S, Myburgh J, Norton R, Scheinkestel C, Su S. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med. 2009;361:1627–38.PubMedCrossRefGoogle Scholar
  13. 13.
    Brunet P, Frances J, Vacher-Coponat H, Jaubert D, Lebrun G, Gondouin B, Duval A, Berland Y. Hemodialysis without heparin: a randomized, controlled, crossover study of two dialysis membranes (AN69ST and polysulfone F60). Int J Artif Organs. 2011;34:1165–71.PubMedCrossRefGoogle Scholar
  14. 14.
    Hanevold C, Lu S, Yonekawa K. Utility of citrate dialysate in management of acute kidney injury in children. Hemodial Int. 2010;14 Suppl 1:S2–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Davenport A, Tolwani A. Citrate anticoagulation for continuous renal replacement therapy (CRRT) in patients with acute kidney injury admitted to the intensive care unit. Nephrol Dial Transplant Plus. 2009;2:439–47.Google Scholar
  16. 16.
    Meier-Kriesche HU, Gitomer J, Kinkel K, DuBose T. Increased total to ionised calcium ratio during continuous venovenous haemodialysis with regional citrate anticoagulation. Crit Care Med. 2001;29:748–52.PubMedCrossRefGoogle Scholar
  17. 17.
    House AA, Anand I, Bellomo R, Cruz D, Bobek I, Anker SD, Aspromonte N, Bagshaw S, Berl T, Daliento L, Davenport A, Haapio M, Hillege H, McCullough P, Katz N, Maisel A, Mankad S, Zanco P, Mebazaa A, Palazzuoli A, Ronco F, Shaw A, Sheinfeld G, Soni S, Vescovo G, Zamperetti N, Ponikowski P, Ronco C, Acute Dialysis Quality Initiative Consensus Group. Definition and classification of Cardio-Renal Syndromes: workgroup statements from the 7th ADQI Consensus Conference. Nephrol Dial Transplant. 2010;25:1416–20.PubMedCrossRefGoogle Scholar
  18. 18.
    Bagshaw SM, Cruz DN, Aspromonte N, Daliento L, Ronco F, Sheinfeld G, Anker SD, Anand I, Bellomo R, Berl T, Bobek I, Davenport A, Haapio M, Hillege H, House A, Katz N, Maisel A, Mankad S, McCullough P, Mebazaa A, Palazzuoli A, Ponikowski P, Shaw A, Soni S, Vescovo G, Zamperetti N, Zanco P, Ronco C, Acute Dialysis Quality Initiative Consensus Group. Epidemiology of cardio-renal syndromes: workgroup statements from the 7th ADQI Consensus Conference. Nephrol Dial Transplant. 2010;25:1406–16.PubMedCrossRefGoogle Scholar
  19. 19.
    Wszolek ZK, McComb RD, Pfeiffer RF, Steg RE, Wood RP, Shaw Jr BW, Markin RS. Pontine and extrapontine myelinolysis following liver transplantation. Relationship to serum sodium. Transplantation. 1989;48:1006–12.PubMedCrossRefGoogle Scholar
  20. 20.
    Winchester JF, Harbord NB, Rosen H. Management of poisonings: core curriculum 2010. Am J Kidney Dis. 2010;56:788–800.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.UCL Centre for NephrologyRoyal Free HospitalLondonUK

Personalised recommendations