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Renal replacement therapy in critically ill patients with acute kidney injury--when to start.
Nephrol Dial Transplant. 2012 Jun; 27(6):2242-8.ND

Abstract

BACKGROUND

Despite the frequent use of renal replacement therapy (RRT) for patients with acute kidney injury (AKI) in the intensive care unit (ICU), there is no accepted consensus on the optimal indications and timing.

METHODS

The aim of this paper is to identify optimal triggers for RRT in critically ill patients with AKI.

RESULTS

We examined data from 2 randomized controlled trials, 2 prospective studies and 13 retrospective trials and found large variation in the different parameters and cut-offs for initiation of RRT. No single biochemical parameter was adequate to define the optimal indication and time to commence RRT. Degree of fluid overload, oliguria and associated non-renal organ failure appeared to be more appropriate parameters for initiation of RRT. We propose a clinical algorithm based on regular assessment of the patient's condition and trends in these parameters. It is intended to aid the process of deciding when to start RRT in critically ill adult patients with AKI.

CONCLUSION

Available evidence suggests that the decision when to start RRT in critically ill patients with AKI should be based on trends in the patient's severity of illness, presence of oliguria and fluid overload and associated non-renal organ failure rather than specific serum creatinine or urea values.

Authors+Show Affiliations

Department of Critical Care, King’s College London, King's Health Partners, Guy's & St Thomas' Foundation Trust, London, UK. Marlies.Ostermann@gstt.nhs.ukNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22231034

Citation

Ostermann, Marlies, et al. "Renal Replacement Therapy in Critically Ill Patients With Acute Kidney Injury--when to Start." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 27, no. 6, 2012, pp. 2242-8.
Ostermann M, Dickie H, Barrett NA. Renal replacement therapy in critically ill patients with acute kidney injury--when to start. Nephrol Dial Transplant. 2012;27(6):2242-8.
Ostermann, M., Dickie, H., & Barrett, N. A. (2012). Renal replacement therapy in critically ill patients with acute kidney injury--when to start. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 27(6), 2242-8. https://doi.org/10.1093/ndt/gfr707
Ostermann M, Dickie H, Barrett NA. Renal Replacement Therapy in Critically Ill Patients With Acute Kidney Injury--when to Start. Nephrol Dial Transplant. 2012;27(6):2242-8. PubMed PMID: 22231034.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Renal replacement therapy in critically ill patients with acute kidney injury--when to start. AU - Ostermann,Marlies, AU - Dickie,Helen, AU - Barrett,Nicholas A, Y1 - 2012/01/09/ PY - 2012/1/11/entrez PY - 2012/1/11/pubmed PY - 2012/10/4/medline SP - 2242 EP - 8 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 27 IS - 6 N2 - BACKGROUND: Despite the frequent use of renal replacement therapy (RRT) for patients with acute kidney injury (AKI) in the intensive care unit (ICU), there is no accepted consensus on the optimal indications and timing. METHODS: The aim of this paper is to identify optimal triggers for RRT in critically ill patients with AKI. RESULTS: We examined data from 2 randomized controlled trials, 2 prospective studies and 13 retrospective trials and found large variation in the different parameters and cut-offs for initiation of RRT. No single biochemical parameter was adequate to define the optimal indication and time to commence RRT. Degree of fluid overload, oliguria and associated non-renal organ failure appeared to be more appropriate parameters for initiation of RRT. We propose a clinical algorithm based on regular assessment of the patient's condition and trends in these parameters. It is intended to aid the process of deciding when to start RRT in critically ill adult patients with AKI. CONCLUSION: Available evidence suggests that the decision when to start RRT in critically ill patients with AKI should be based on trends in the patient's severity of illness, presence of oliguria and fluid overload and associated non-renal organ failure rather than specific serum creatinine or urea values. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/22231034/Renal_replacement_therapy_in_critically_ill_patients_with_acute_kidney_injury__when_to_start_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfr707 DB - PRIME DP - Unbound Medicine ER -