REVIEW – August 2021

Renal replacement therapy in the intensive care unit

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Acute kidney injury (AKI) occurs in about half of critically ill patients and is associated with high mortality. Renal replacement therapy (RRT) is one of the treatment options to alleviate symptoms associated with AKI. It is essential for an intensivist to know the basics like indications, optimization and potential side effects of RRT. Beyond conventional emergent indications, the optimal timing of RRT should be individualised. For optimal vascular access, the right internal jugular insertion site is preferred. Most intensivists opt to use the continuous form of RRT (CRRT), although
clinical trials to this date have not shown better results compared to intermittent haemodialysis (IHD). Emergency treatment of intoxications or extreme hyperkalemia with IHD may be beneficial even to haemodynamically unstable patients. The optimal prescribed treatment dose for CRRT is between 25 – 30 ml/kg/hour and a weekly Kt/V of 3.9 for IHD. When anticoagulation is required for RRT, most guidelines recommend regional citrate anticoagulation because of higher filter lifespan and lower bleeding events compared to systemic anticoagulation. The most common side effects of RRT are hypotension and hypothermia.