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

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...

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Published inBlood purification Vol. 44; no. 2; pp. 140 - 155
Main Authors Clark, William R., Leblanc, Martine, Ricci, Zaccaria, Ronco, Claudio
Format Journal Article
LanguageEnglish
Published Basel, Switzerland 01.01.2017
Subjects
Acute Kidney Injury - blood
Acute Kidney Injury - therapy
Algorithms
Critical Illness
Humans
In-Depth Review
Kidney Failure, Chronic - blood
Kidney Failure, Chronic - therapy
Kinetics
Renal Replacement Therapy - methods
Urea - blood
Solute kinetics
Urea
Hemodialysis
Acute kidney injury
Critical care
Clearance
Standard Kt/V
Continuous renal replacement therapy
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Summary: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
Bibliography:ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-3
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ObjectType-Review-1
ISSN:0253-5068
1421-9735
DOI:10.1159/000475457