Lecture Summary

Acute Kidney Injury (AKI) affects nearly 40% of intensive care unit (ICU) patients and carries significant morbidity and mortality. Once AKI is established, renal replacement therapy (RRT) is the mainstay of supportive care. The best time to initiate RRT is still unclear. Although several studies have evaluated early vs. late RRT in AKI, there is no clear consensus on how “early” or “late” should be defined. Existing evidence does not support the initiation of RRT based on any particular stage of AKI. Risk-benefit of RRT along with the host's ability to tolerate homeostatic derangements should be taken into account prior to initiating RRT. Continuous RRT (CRRT) has not been shown to be superior to intermittent hemodialysis (IHD). A CRRT dose of at least 20ml/kg/hour or an IHD dose of Kt/V 1.2 thrice a week seems to be adequate for patients with AKI in the ICU. Improvement of urine output and trend in azotemia can serve as a guide in weaning and termination of RRT. Diuretics have not been shown to decrease the need or frequency of RRT.

Target Audience

Critical Care Doctors
Advanced Critical Care Nurse Practitioners

Learning Objectives:

Upon completion of this activity, you should be able to:

• understand the nomenclature of various techniques of renal replacement therapy (RRT)
• understand various aspects of RRT including timing of initiation, modality, dose and termination
• apply current existing evidence to the clinical practice of RRT

None.