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Crit Care Res Pract. 2019 Jul 16;2019:6948710. doi: 10.1155/2019/6948710. eCollection 2019.

Renal Replacement Therapy in the Critical Care Setting.

Author information

1
MB BCh BAO MRCPI MRCP(UK) PGDip (ClinEd), Holder of European Certificate in Nephrology, University Hospital Galway, Galway, Ireland.
2
MB BCh BAO MRCPI, Specialist Registrar in Nephrology, University Hospital Galway, Galway, Ireland.
3
MB BCh FRCPI PhD (NUI), Consultant Nephrologist, University Hospital Galway, Galway, Ireland.

Abstract

Renal replacement therapy (RRT) is frequently required to manage critically ill patients with acute kidney injury (AKI). There is limited evidence to support the current practice of RRT in intensive care units (ICUs). Recently published randomized control trials (RCTs) have further questioned our understanding of RRT in critical care. The optimal timing and dosing continues to be debatable; however, current evidence suggests delayed strategy with less intensive dosing when utilising RRT. Various modes of RRT are complementary to each other with no definite benefits to mortality or renal function preservation. Choice of anticoagulation remains regional citrate anticoagulation in continuous renal replacement therapy (CRRT) with lower bleeding risk when compared with heparin. RRT can be used to support resistant cardiac failure, but evolving therapies such as haemoperfusion are currently not recommended in sepsis.

Conflict of interest statement

The authors declare no potential conflicts of interest.

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