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J Renal Inj Prev. 2016 Nov 6;6(1):35-42. doi: 10.15171/jrip.2017.07. eCollection 2017.

Volume-related weight gain as an independent indication for renal replacement therapy in the intensive care units.

Author information

1
Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA.
2
FMC Extracorporeal Life Support Center, Fresenius Medical Care Hungary, Medical and Health Science Centre, University of Debrecen, Debrecen, Hungary.
3
Division of Transplantation, Institute of Surgery, University of Debrecen, Debrecen, Hungary.
4
Fresenius Medical Care, Semmelweis University, Budapest, Hungary.
5
Carolinas Campus, Edward Via Osteopathic College of Medicine, Spartanburg, SC, USA.
6
Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
7
Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary.
8
Institute of Pathophysiology, Semmelweis University, Budapest, Hungary.

Abstract

Attempts to identify specific therapies to reverse acute kidney injury (AKI) have been unsuccessful in the past; only modifying risk profile or addressing the underlying disease processes leading to AKI proved efficacious. The current thinking on recognizing AKI is compromised by a "kidney function percent-centered" viewpoint, a paradigm further reinforced by the emergence of serum creatinine-based automated glomerular filtration reporting over the last two decades. Such thinking is, however, grossly corrupted for AKI and poorly applicable in critically ill patients in general. Conventional indications for renal replacement therapy (RRT) may have limited applicability in critically ill patients and there has been a relative lack of progress on RRT modalities in these patients. AKI in critically ill patients is a highly complex syndrome and it may be counterproductive to produce complex clinical practice guidelines, which are labor and resource-intensive to maintain, difficult to memorize or may not be immediately available in all settings all over the world. Additionally, despite attempts to develop reliable and reproducible biomarkers to replace serum creatinine as a guide to therapy such biomarkers failed to materialize. Under such circumstances, there is an ongoing need to reassess the practical value of simple measures, such as volume-related weight gain (VRWG) and urine output, both for prognostic markers and clinical indicators for the need for RRT. This current paper reviews the practical utility of VRWG as an independent indication for RRT in face of reduced urine output and hemodynamic instability.

KEYWORDS:

Acute kidney injury; Biomarkers; Critical illness; Oliguria; Renal failure; Volume overload

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