Renal Replacement Therapy for Septic Acute Kidney Injury

Patients with septic acute kidney injury (AKI) receiving renal replacement therapy have mortality rates among the highest of all critical illnesses. Although the incidence of septic AKI is increasing and renal replacement therapies are being used more frequently, there remain many uncertainties about how this treatment is best applied.Techniques for renal replacement in the critically ill have become refined over the past two decades. Use of these therapies had been guided largely by clinical experience and observational studies. More recently, controlled clinical studies, most with large cohorts of septic AKI patients, are providing greater insights into the appropriate use of renal replacement therapies.This chapter outlines issues to consider when applying renal replacement to patients with septic AKI. It will include discussion on duration modes (continuous and intermittent), clearance modes (filtration and dialysis), importance of fluid volume control, the amount of clearance (dose), developments in filter composition, and the stage of disease best to commence renal replacement (timing).