Review article: Renal support in critical illness

Sean M. Bagshaw, Rinaldo Bellomo, Prasad Devarajan, Curtis Johnson, C. J. Karvellas, D. James Kutsiogiannis, Ravindra Mehta, Neesh Pannu, Adam Romanovsky, Geoffrey Sheinfeld, Samantha Taylor, Michael Zappitelli, R. T.Noel Gibney

Research output: Contribution to journalReview ArticleResearchpeer-review

16 Citations (Scopus)

Abstract

Purpose: This review provides a focused and comprehensive update on established and emerging evidence in acute renal replacement therapy (RRT) for critically ill patients with acute kidney injury (AKI). Principal findings: There have been considerable technological innovations in the methods and techniques for provision of extracorporeal RRT in critical illness. These have greatly expanded our capability to provide both renal and non-renal life-sustaining organ support for critically ill patients. Recent data suggest earlier initiation of RRT in AKI may confer an advantage for survival and renal recovery. Two large trials have recently shown no added benefit to augmented RRT dose delivery in AKI. Observational data have also suggested that fluid accumulation in critically ill patients with AKI is associated with worse clinical outcome. However, several fundamental clinical questions remain to be answered, including issues regarding the time to ideally initiate/discontinue RRT, the role of high-volume hemofiltration or other blood purification techniques in sepsis, and extracorporeal support for combined liver-kidney failure. Extracorporeal support with RRT in sepsis, rhabdomyolysis, and liver failure are discussed, along with strategies for drug dosing and management of RRT in sodium disorders. Conclusions: We anticipate that this field will continue to expand to promote research and innovation, hopefully for the benefit of sick critically ill patients.

Original languageEnglish
Pages (from-to)999-1013
Number of pages15
JournalCanadian Journal of Anesthesia
Volume57
Issue number11
DOIs
Publication statusPublished - 1 Nov 2010
Externally publishedYes

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