Timing, dose and mode of dialysis in acute kidney injury

Zaccaria Ricci, Claudio Ronco

Research output: Contribution to journalArticle

Abstract

Purpose of review: In the past 3 years substantial progress has been made in the field of renal replacement therapy (RRT) for critically ill patients. Recent findings: Two important multicenter randomized clinical trials have been recently published and extensively discussed: the randomized evaluation of normal versus augmented level (RENAL) replacement therapy study and the VA/NIH Acute Renal Failure Trial Network (ATN) study. The RENAL and ATN studies were designed to compare 'normal' or 'less intensive' renal support to an 'augmented' or 'intensive' therapy: both studies showed no benefit in outcomes by increases in intensity of RRT dose. The definition of 'normal dose' is now recommended in a range of 20-30 ml/kg per h for continuous therapies and/or thrice weekly intermittent hemodialysis. On the contrary, the complex issue of RRT optimal timing still remains uncertain and controversial. Summary: Wide variations in clinical practice still require RRT for critically ill patients to be optimized. The ideal prescription does not exist; however, continuous hemofiltration at a dose of 30 ml/kg/h meets many requirements of optimal care. In order to shed some light in the issue of RRT timing, furthermore, in the near future a standardized and clinically relevant definition of 'early' RRT should be provided. Great expectations currently rely on the utilization of acute kidney injury severity classifications and on new biomarkers of renal function.

Original languageEnglish
Pages (from-to)556-561
Number of pages6
JournalCurrent Opinion in Critical Care
Volume17
Issue number6
DOIs
Publication statusPublished - Dec 2011

Keywords

  • acute kidney injury
  • dialysis dose
  • dialysis modality
  • hemofiltration
  • timing of renal replacement therapy

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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