The Concept of Renal Replacement Therapy Dose and Efficiency

The issue of acute dialysis dose prescription has undergone significant revision in the last 10 years. The previous idea that critically ill patients' survival was proportional to delivered dialysis being the highest with the highest dose has been downplayed. The best evidence supports a continuous renal replacement therapy dose of at least 25mL/kg/hr of effluent flow rate, for venovenous hemofiltration, hemodialysis, or hemodiafiltration. However, if standard dose prescription may be recommended at the start of an acute dialytic treatment, strict control of delivered dose is recommended for adequate delivery of the prescribed dose. Furthermore, prescription and delivery should be reassessed frequently to meet the patients' needs, tailoring the removal of solutes to the complex and rapidly changing metabolism of different patients.