ISCCM Guidelines on Acute Kidney Injury and Renal Replacement Therapy (original) (raw)
Related papers
2022
ISCCM Guidelines on Acute Kidney Injury and Renal Replacement Therapy Rajesh C Mishra1 , Kanwalpreet Sodhi2 , Kowdle Chandrasekhar Prakash3 , Niraj Tyagi4 , Gunjan Chanchalani5 , Rajeev A Annigeri6 , Deepak Govil7 , Raymond D Savio8 , Balasubramanian Subbarayan9 , Nitin Arora10 , Ranajit Chatterjee11 , Jose Chacko12 , Ruchira W Khasne13 , Rajasekara M Chakravarthi14 , Nita George15 , Ahsan Ahmed16 , Yash Javeri17 , Akshay K Chhallani18 , Reshu G Khanikar19 , Saravanan Margabandhu20 , Ahsina J Lopa21 , Dhruva Chaudhry22 , Srinivas Samavedam23 , Arindam Kar24 , Subhal B Dixit25 , Palepu Gopal26
Renal replacement therapy for acute kidney injury in the intensive care unit
Nephrologie & Therapeutique, 2017
Renal replacement therapy for acute kidney injury has been used for more than 60 years. Except when life-threatening metabolic complications such as severe hyperkalaemia are present, renal replacement therapy initiation criteria are the subject of intense debate. Significant progress has been made with the publication of the AKIKI multicenter trial, which showed that a delayed renal replacement therapy initiation strategy (in the absence of life-threatening metabolic complications) was not associated with a difference in mortality compared to an early renal replacement therapy initiation strategy. In addition, this delayed strategy obviated the need for renal replacement therapy in almost 50% of cases was associated with a more rapid renal function recovery and with a lower incidence of catheter-bloodstream related infections. Research on renal replacement therapy modalities (continuous vs. intermittent renal replacement therapy, citrate vs. heparin anticoagulation, jugular vs. femoral catheterization) did not show any obvious superiority of one modality over another. Thus, the choice depends mainly on local considerations (patient recruitment, availability of modalities, staff experience). The criteria for renal replacement therapy discontinuation are still unclear due to difficulties in assessing renal function recovery. Urine output remains the main criteria in the decision to wean from renal replacement therapy. Pending the confirmation of AKIKI trial by similar studies in progress, it seems reasonable to choose a delayed renal replacement therapy initiation strategy under watchful surveillance in case of severe acute kidney injury in the absence of life-threatening metabolic complications.
Acute kidney injury and renal replacement therapy in the intensive care unit
Nursing in Critical Care, 2009
Background: Renal replacement therapy (RRT) is now offered as a routine treatment in most intensive care units (ICU) in the UK for patients suffering from acute kidney injury (AKI). It is important for all ICU staff to understand the underlying principles of the available therapeutic options and the possible complications thereof. Aims and objectives: The objective of this review was to provide an accessible theoretical and practical update on the management of RRT. In addition to a detailed discussion of the underlying principles and indications for the various modes of RRT, we will discuss the assessment of kidney function, possible complications and anticoagulation during RRT, following a review of the current literature. Search strategies: Pubmed, Medline and the Cumulative Index to Nursing and Allied Health Literature were searched using the keywords renal function, RRT, dialysis, renal failure kidney injury, together with intensive care, intensive therapy and critical care. We included only studies published in English from 1998 to 2008 and from these identified and included additional publications. The 12 most relevant publications are referenced in this review. Conclusion: AKI is associated with increased mortality in ICU, and RRT should be considered early in the disease process. Continuous haemofiltration is the most common modality of treatment in this group of patients, and a detailed knowledge of the management of such patients is required.
International Survey on the Management of Acute Kidney Injury in Critically Ill Patients: Year 2007
2010
sion, filter clotting, vascular access and sepsis treatment were the most frequent complications and concerns of RRT. Conclusions: New classifications such as the RIFLE criteria did improve the well-known uncertainty about the definition of AKI. Awareness of the prescription and standardization of an adequate treatment dose seemed to have increased in recent years, even if there is still a significant level of uncertainty on this specific issue. Several concerns and RRT complications, such as bleeding and anticoagulation strategies, still need further exploration and development.
Renal Replacement Therapy in Intensive Care Unit: 10 Commandments
Academia Letters, 2021
Renal replacement therapy in intensive care units have evolved extensively in last 30 years. The concept of renal replacement and renal support are vital part of organ support in critically ill patients.1 It was 2012 when KDIGO published guideline for acute kidney injury (AKI), it's pathogenesis and management. This helps nephrologists treat critically ill patients in ICUs in a rational way which is supported by authentic data and inferences. Indian data on AKI and dialytic therapies used in AKI is sparse. Whether or not to provide RRT, and when to start, are two of the fundamental questions facing nephrologists and intensive-care practitioners in most cases of severe AKI.2 This is our attempt to simplify the understanding of renal replacement therapy in intensive care units which will help us in managing patients with critical conditions.
Renal Replacement Therapy in Acute Kidney Injury: Which Mode and When?
Indian Journal of Critical Care Medicine, 2014
Renal replacement therapy (RRT) for acute kidney injury (AKI) patients in an intensive care unit (ICU) presents unique problems of providing biochemical and fluid removal in patients with unstable circulations, inotropes, and increased capillary permeability. Although no individual modality has been shown to confer a mortality benefit, it is assumed that continuous therapies like peritoneal dialysis (PD) and venovenous hemofiltration or hemodiafiltration may be better tolerated by the patient with hemodynamic instability, raised intracranial pressure (ICP), and liver failure. An individual patient may require more than one treatment in the course of his/her illness. The therapies offered may reflect available resources, local expertise, and cost constraints.
Renal replacement therapy in acute kidney injury
About 4% of intensive care unit (ICU) patients worldwide have acute kidney injury (AKI) and require renal replacement therapy (RRT). The choice of modality has expanded from intermittent hemodialysis (IHD) and peritoneal dialysis (PD), where solute clearance is by diffusion, to include continuous renal replacement therapy (CRRT) where convection is the predominant mode of clearance and sustained low-efficiency dialysis (SLED) which involves very slow diffusive clearance without hemodynamic compromise. SLED is considered equivalent to CRRT and is a much less expensive therapy. Early referral to nephrologist improves outcome but the effect of early RRT initiation is still unclear. Fluid overload seems to portend a bad outcome and the benefit of RRT early when there is fluid overload awaits confirmation in a study. The raging debate about dosing of RRT over the past decade seems to be over with the general consensus that increasing RRT dose above a CRRT dose of 20 mL/kg/min may not be beneficial. Heparin anticoagulation is least necessary for IHD. Regional anticoagulation with citrate is possible with need for careful monitoring of pH, ionized calcium and electrolytes. Although largely given up in the west, PD is still an important RRT modality. Various PD techniques are now available for tailoring therapy. PD is the RRT modality of choice in children but CRRT has been increasing in popularity. Newer exciting RRT modalities and other advances are evolving for the treatment of patients with AKI and future trials confirming their clinical utility and safety are awaited.
New experiences with the therapy of acute kidney injury
Prilozi / Makedonska akademija na naukite i umetnostite, Oddelenie za biološki i medicinski nauki = Contributions / Macedonian Academy of Sciences and Arts, Section of Biological and Medical Sciences, 2008
Acute kidney injury (AKI) is encountered in a variety of settings (e.g., hospitalized and outpatient, non-intensive and intensive care unit patients, pediatric, adult, and elderly), with varied clinical manifestations ranging from a minimal elevation of serum creatinine (SCr) to anuric renal failure and/or multi organ failure (MOF), and a wide variation in causes, risk factors and comorbiditis. There is no hard and fast rule as to when renal replacement therapy (RRT) should be initiated, but is clearly not sensible to wait until an obvious uremic complication arises. Modern practice is to initiate RRT sooner rather than later, for example, when the SCr concentration reaches 500-700 micromol/L, perhaps even earlier, unless there is clear evidence that renal function is about to recover. The choice of the treatment will depend on the clinical practice, technical resources, and well-trained nurses of a given department, than on precise clinical indication. The ideal RRT should mimic th...
Management of Renal Replacement Therapy in Acute Kidney Injury
Clinical Journal of the American Society of Nephrology, 2007
Background: Data on current practices for management of renal replacement therapy (RRT) in acute kidney injury (AKI) are limited, particularly with regard to the dosing of therapy. Design, setting, participants, and measurements: A survey was conducted of practitioners at the 27 study sites that participate in the Veterans Affairs/National Institutes of Health Acute Renal Trial Network (ATN) Study before initiation of patient enrollment for ascertainment of the local prevailing practices for management of RRT in critically ill patients with AKI. Surveys were returned from 130 practitioners at 26 of 27 study sites; the remaining study site provided aggregate data. Results: Intermittent hemodialysis and continuous RRT were the most commonly used modalities of RRT, with sustained low-efficiency dialysis and other "hybrid" treatments used in fewer than 10% of patients. Intermittent hemodialysis was most commonly provided on a thrice-weekly or every-other-day schedule, with only infrequent assessment of the delivered dosage of therapy. Most practitioners reported that they did not dose continuous RRT on the basis of patient weight. The average prescribed dosage of therapy corresponded to a weight-based dosage of no more than 20 to 25 ml/kg per h. Conclusions: These results provide insight into clinical management of RRT and provide normative data for evaluation of the design of ongoing clinical trials.