Quantification and Dosing of Renal Replacement Therapy in Acute Kidney Injury: A Reappraisal

William R. Clark, Martine Leblanc, Zaccaria Ricci, Claudio Ronco

Research output: Contribution to journalArticle

Abstract

Background/Aims: Delivered dialysis therapy is routinely measured in the management of patients with end-stage renal disease; yet, the quantification of renal replacement prescription and delivery in acute kidney injury (AKI) is less established. While continuous renal replacement therapy (CRRT) is widely understood to have greater solute clearance capabilities relative to intermittent therapies, neither urea nor any other solute is specifically employed for CRRT dose assessments in clinical practice at present. Instead, the normalized effluent rate is the gold standard for CRRT dosing, although this parameter does not provide an accurate estimation of actual solute clearance for different modalities. Methods: Because this situation has created confusion among clinicians, we reappraise dose prescription and delivery for CRRT. Results: A critical review of RRT quantification in AKI is provided. Conclusion: We propose an adaptation of a maintenance dialysis parameter (standard Kt/V) as a benchmark to supplement effluent-based dosing of CRRT. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=475457

Original languageEnglish
Pages (from-to)140-155
Number of pages16
JournalBlood Purification
Volume44
Issue number2
DOIs
Publication statusPublished - Jun 1 2017

Keywords

  • Acute kidney injury
  • Clearance
  • Continuous renal replacement therapy
  • Critical care
  • Hemodialysis
  • Solute kinetics
  • Standard Kt/V
  • Urea

ASJC Scopus subject areas

  • Hematology
  • Nephrology

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