TY  - CHAP
M1  - Book, Section
TI  - Renal Replacement Therapy for Acute Kidney Injury in the Intensive Care Unit
A1  - Côté, Jean Maxime
A1  - Koyner, Jay L.
A1  - Murray, Patrick T.
A2  - Schmidt, Gregory A.
A2  - Kress, John P.
A2  - Douglas, Ivor S.
PY  - 2023
T2  - Hall, Schmidt and Wood’s Principles of Critical Care, 5<sup>th</sup> Edition
AB  - KEY  POINTSThe  main  goals  of  renal  replacement  therapy  (RRT)  for  acute  kidney  injury  (AKI)  are  to  provide  solute  clearance  and  homeostasis  (electrolytes,  acid–base,  and  volume  status),  while  personalizing  renal  support  to  facilitate  other  aspects  of  care  of  the  critically  ill  patient  (fluid  balance,  nutritional  support,  etc.).Indications  for  initiation  of  RRT  for  AKI  should  be  conservative;  in  the  absence  of  emergency  indications,  a  strategy  of  watchful  waiting  should  be  taken.In  the  setting  of  AKI,  no  specific  RRT  modality  provides  a  proven  mortality  benefit  over  another.  However,  specific  clinical  scenarios  (e.g.,  acute  liver  failure,  increased  intracranial  pressure,  severe  hemodynamic  instability)  may  mandate  a  particular  approach.In  the  setting  of  AKI,  a  minimum  dose  of  20  to  25  mL/kg/h  of  continuous  renal  replacement  therapy  (CRRT)  should  be  delivered.  Data  on  dosing  of  intermittent  dialysis  suggest  prescription  of  a  minimum  Kt/Vurea  of  1.2  per  treatment  three  times  a  week.  Additional  treatments  may  be  required  for  volume  control  or  inadequate  solute  clearance.Regarding  anticoagulation  to  maintain  the  extracorporeal  circuit  function,  options  include  heparin,  citrate,  and  no  anticoagulation.  Each  has  its  own  risks  and  benefits.  In  continuous  modalities,  citrate  is  associated  with  longer  filter  lifespan.In  the  setting  of  AKI  requiring  RRT,  nutritional  support  for  proteins  and  energy  should  follow  the  current  ASPEN  guidelines.  For  micronutrients  and  vitamins,  data  are  lacking  to  recommend  a  particular  approach.Depending  on  the  modality  and  intensity  of  RRT,  dosing  strategies  for  medications  (including  antimicrobials)  differ  significantly.  Adherence  to  dosing  guidelines  ensures  that  the  targeted  therapeutic  dose  is  delivered,  as  inappropriate  dosing  has  a  significant  impact  on  patient  outcomes  and  increases  the  risk  of  mortality.  
SN  - 
PB  - McGraw Hill
CY  - New York, NY
Y2  - 2024/09/18
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1201808929
ER  -