Skip to main content
Top
Published in: Critical Care 3/2015

Open Access 01-12-2015 | Review

Challenges and pitfalls when implementing renal replacement therapy in the ICU

Author: Ravindra L Mehta

Published in: Critical Care | Special Issue 3/2015

Login to get access

Abstract

Several new methods of renal replacement therapy (RRT) are now available for treating patients in the ICU setting. However, utilization of RRT in the ICU is subject to considerable variation and the need for RRT is associated with worse outcomes. Several factors influence the application of dialysis and reflect the interplay of patient and process of care elements that are dynamic in nature. Despite multiple studies evaluating RRT and its application, there are gaps in our knowledge that must be overcome to improve outcomes. This article discusses some of the important issues that require attention in delivering RRT in critically ill patients and provides a framework for the optimal use of RRT in the ICU.
Literature
1.
go back to reference Tolwani A: Continuous renal-replacement therapy for acute kidney injury. N Engl J Med. 2013, 368: 1160-1.PubMedCrossRef Tolwani A: Continuous renal-replacement therapy for acute kidney injury. N Engl J Med. 2013, 368: 1160-1.PubMedCrossRef
2.
go back to reference D'Intini V, Ronco C, Bonello M, Bellomo R: Renal replacement therapy in acute renal failure. Best Pract Res Clin Anaesthesiol. 2004, 18: 145-57.PubMedCrossRef D'Intini V, Ronco C, Bonello M, Bellomo R: Renal replacement therapy in acute renal failure. Best Pract Res Clin Anaesthesiol. 2004, 18: 145-57.PubMedCrossRef
3.
4.
go back to reference Mehta RL: Indications for dialysis in the ICU: renal replacement vs. renal support. Blood Purif. 2001, 19: 227-32.PubMedCrossRef Mehta RL: Indications for dialysis in the ICU: renal replacement vs. renal support. Blood Purif. 2001, 19: 227-32.PubMedCrossRef
5.
go back to reference Karvellas CJ, Farhat MR, Sajjad I, Mogensen SS, Leung AA, Wald R, Bagshaw SM: A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis. Crit Care. 2011, 15: R72-PubMedPubMedCentralCrossRef Karvellas CJ, Farhat MR, Sajjad I, Mogensen SS, Leung AA, Wald R, Bagshaw SM: A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis. Crit Care. 2011, 15: R72-PubMedPubMedCentralCrossRef
6.
go back to reference Zarbock A, Singbartl K, Kellum JA: Evidence-based renal replacement therapy for acute kidney injury. Minerva Anestesiol. 2009, 75: 135-9.PubMed Zarbock A, Singbartl K, Kellum JA: Evidence-based renal replacement therapy for acute kidney injury. Minerva Anestesiol. 2009, 75: 135-9.PubMed
7.
go back to reference Macedo E, Mehta RL: When should renal replacement therapy be initiated for acute kidney injury?. Semin Dial. 2011, 24: 132-7.PubMedCrossRef Macedo E, Mehta RL: When should renal replacement therapy be initiated for acute kidney injury?. Semin Dial. 2011, 24: 132-7.PubMedCrossRef
8.
go back to reference Lameire N, Vanbiesen W, Vanholder R: When to start dialysis in patients with acute kidney injury? When semantics and logic become entangled with expectations and beliefs. Crit Care. 2011, 15: 171-PubMedPubMedCentralCrossRef Lameire N, Vanbiesen W, Vanholder R: When to start dialysis in patients with acute kidney injury? When semantics and logic become entangled with expectations and beliefs. Crit Care. 2011, 15: 171-PubMedPubMedCentralCrossRef
9.
go back to reference Ricci Z, Ronco C: Timing, dose and mode of dialysis in acute kidney injury. Curr Opin Crit Care. 2011, 17: 556-61.PubMedCrossRef Ricci Z, Ronco C: Timing, dose and mode of dialysis in acute kidney injury. Curr Opin Crit Care. 2011, 17: 556-61.PubMedCrossRef
10.
go back to reference Palevsky PM: Renal replacement therapy I: indications and timing. Crit Care Clin. 2005, 21: 347-56.PubMedCrossRef Palevsky PM: Renal replacement therapy I: indications and timing. Crit Care Clin. 2005, 21: 347-56.PubMedCrossRef
11.
go back to reference Granata A, D'Intini V, Bellomo R, Ronco C: Vascular access for acute extracorporeal renal replacement therapies. Contrib Nephrol. 2004, 142: 159-77.PubMedCrossRef Granata A, D'Intini V, Bellomo R, Ronco C: Vascular access for acute extracorporeal renal replacement therapies. Contrib Nephrol. 2004, 142: 159-77.PubMedCrossRef
12.
go back to reference Macedo E, Mehta RL: When should renal replacement therapy be initiated for acute kidney injury?. Semin Dial. 2011, 24: 132-7.PubMedCrossRef Macedo E, Mehta RL: When should renal replacement therapy be initiated for acute kidney injury?. Semin Dial. 2011, 24: 132-7.PubMedCrossRef
13.
go back to reference Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, La Greca G: Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet. 2000, 356: 26-30.PubMedCrossRef Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, La Greca G: Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet. 2000, 356: 26-30.PubMedCrossRef
14.
go back to reference Palevsky PM, Zhang JH, O'Connor TZ, Chertow GM, Crowley ST, Choudhury D, Finkel K, Kellum JA, Paganini E, Schein RM, et al: Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008, 359: 7-20.PubMedCrossRef Palevsky PM, Zhang JH, O'Connor TZ, Chertow GM, Crowley ST, Choudhury D, Finkel K, Kellum JA, Paganini E, Schein RM, et al: Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008, 359: 7-20.PubMedCrossRef
15.
go back to reference Vesconi S, Cruz DN, Fumagalli R, Kindgen-Milles D, Monti G, Marinho A, Mariano F, Formica M, Marchesi M, Rene R, et al: Delivered dose of renal replacement therapy and mortality in critically ill patients with acute kidney injury. Crit Care. 2009, 13: R57-PubMedPubMedCentralCrossRef Vesconi S, Cruz DN, Fumagalli R, Kindgen-Milles D, Monti G, Marinho A, Mariano F, Formica M, Marchesi M, Rene R, et al: Delivered dose of renal replacement therapy and mortality in critically ill patients with acute kidney injury. Crit Care. 2009, 13: R57-PubMedPubMedCentralCrossRef
16.
go back to reference Palevsky PM, Zhang JH, O'Connor TZ, Chertow GM, Crowley ST, Choudhury D, Finkel K, Kellum JA, Paganini E, Schein RM, et al: Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008, 359: 7-20.PubMedCrossRef Palevsky PM, Zhang JH, O'Connor TZ, Chertow GM, Crowley ST, Choudhury D, Finkel K, Kellum JA, Paganini E, Schein RM, et al: Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008, 359: 7-20.PubMedCrossRef
17.
go back to reference Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lo S, McArthur C, McGuinness S, Myburgh J, Norton R, et al: Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med. 2009, 361: 1627-38.PubMedCrossRef Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lo S, McArthur C, McGuinness S, Myburgh J, Norton R, et al: Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med. 2009, 361: 1627-38.PubMedCrossRef
18.
go back to reference Macedo E, Claure-Del Granado R, Mehta RL: Effluent volume and dialysis dose in CRRT: time for reappraisal. Nat Rev Nephrol. 2012, 8: 57-60.CrossRef Macedo E, Claure-Del Granado R, Mehta RL: Effluent volume and dialysis dose in CRRT: time for reappraisal. Nat Rev Nephrol. 2012, 8: 57-60.CrossRef
19.
go back to reference Mehta RL, McDonald B, Gabbai FB, Pahl M, Pascual MT, Farkas A, Kaplan RM: A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure. Kidney Int. 2001, 60: 1154-63.PubMedCrossRef Mehta RL, McDonald B, Gabbai FB, Pahl M, Pascual MT, Farkas A, Kaplan RM: A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure. Kidney Int. 2001, 60: 1154-63.PubMedCrossRef
20.
go back to reference Venkataraman R, Kellum JA, Palevsky P: Dosing patterns for continuous renal replacement therapy at a large academic medical center in the United States. J Crit Care. 2002, 17: 246-50.PubMedCrossRef Venkataraman R, Kellum JA, Palevsky P: Dosing patterns for continuous renal replacement therapy at a large academic medical center in the United States. J Crit Care. 2002, 17: 246-50.PubMedCrossRef
21.
go back to reference Uchino S, Fealy N, Baldwin I, Morimatsu H, Bellomo R: Continuous is not continuous: the incidence and impact of circuit "down-time" on uraemic control during continuous veno-venous haemofiltration. Intensive Care Med. 2003, 29: 575-8.PubMedCrossRef Uchino S, Fealy N, Baldwin I, Morimatsu H, Bellomo R: Continuous is not continuous: the incidence and impact of circuit "down-time" on uraemic control during continuous veno-venous haemofiltration. Intensive Care Med. 2003, 29: 575-8.PubMedCrossRef
22.
go back to reference Kumar VA, Yeun JY, Depner TA, Don BR: Extended daily dialysis vs. continuous hemodialysis for ICU patients with acute renal failure: a two-year single center report. Int J Artif Organs. 2004, 27: 371-9.PubMed Kumar VA, Yeun JY, Depner TA, Don BR: Extended daily dialysis vs. continuous hemodialysis for ICU patients with acute renal failure: a two-year single center report. Int J Artif Organs. 2004, 27: 371-9.PubMed
23.
go back to reference Feldhoff P, Turnham T, Klein E: Effect of plasma proteins on the sieving spectra of hemofilters. Artif Organs. 1984, 8: 186-92.PubMedCrossRef Feldhoff P, Turnham T, Klein E: Effect of plasma proteins on the sieving spectra of hemofilters. Artif Organs. 1984, 8: 186-92.PubMedCrossRef
24.
go back to reference Prowle JR, Schneider A, Bellomo R: Clinical review: Optimal dose of continuous renal replacement therapy in acute kidney injury. Crit Care. 2011, 15: 207-PubMedPubMedCentralCrossRef Prowle JR, Schneider A, Bellomo R: Clinical review: Optimal dose of continuous renal replacement therapy in acute kidney injury. Crit Care. 2011, 15: 207-PubMedPubMedCentralCrossRef
25.
go back to reference Mehta RL, Bouchard J: Controversies in acute kidney injury: effects of fluid overload on outcome. Contrib Nephrol. 2011, 174: 200-11.PubMedCrossRef Mehta RL, Bouchard J: Controversies in acute kidney injury: effects of fluid overload on outcome. Contrib Nephrol. 2011, 174: 200-11.PubMedCrossRef
27.
go back to reference Moss AH: Shared decision-making in dialysis: the new RPA/ASN guideline on appropriate initiation and withdrawal of treatment. Am J Kidney Dis. 2001, 37: 1081-91.PubMedCrossRef Moss AH: Shared decision-making in dialysis: the new RPA/ASN guideline on appropriate initiation and withdrawal of treatment. Am J Kidney Dis. 2001, 37: 1081-91.PubMedCrossRef
28.
go back to reference Baldwin I, Bellomo R, Koch B: Blood flow reductions during continuous renal replacement therapy and circuit life. Intensive Care Med. 2004, 30: 2074-9.PubMedCrossRef Baldwin I, Bellomo R, Koch B: Blood flow reductions during continuous renal replacement therapy and circuit life. Intensive Care Med. 2004, 30: 2074-9.PubMedCrossRef
29.
go back to reference Zhang L, Baldwin I, Zhu G, Tanaka A, Bellomo R: Automated electronic monitoring of circuit pressures during continuous renal replacement therapy: a technical report. Crit Care Resusc. 2015, 17: 51-4.PubMed Zhang L, Baldwin I, Zhu G, Tanaka A, Bellomo R: Automated electronic monitoring of circuit pressures during continuous renal replacement therapy: a technical report. Crit Care Resusc. 2015, 17: 51-4.PubMed
30.
go back to reference Tolwani AJ, Wille KM: Anticoagulation for continuous renal replacement therapy. Semin Dial. 2009, 22: 141-5.PubMedCrossRef Tolwani AJ, Wille KM: Anticoagulation for continuous renal replacement therapy. Semin Dial. 2009, 22: 141-5.PubMedCrossRef
31.
go back to reference Gattas DJ, Rajbhandari D, Bradford C, Buhr H, Lo S, Bellomo R: A randomized controlled trial of regional citrate versus regional heparin anticoagulation for continuous renal replacement therapy in critically ill adults. Crit Care Med. 2015 Gattas DJ, Rajbhandari D, Bradford C, Buhr H, Lo S, Bellomo R: A randomized controlled trial of regional citrate versus regional heparin anticoagulation for continuous renal replacement therapy in critically ill adults. Crit Care Med. 2015
32.
go back to reference Chanchairujira T, Mehta RL: Assessing fluid change in hemodialysis: whole body versus sum of segmental bioimpedance spectroscopy. Kidney Int. 2001, 60: 2337-42.PubMedCrossRef Chanchairujira T, Mehta RL: Assessing fluid change in hemodialysis: whole body versus sum of segmental bioimpedance spectroscopy. Kidney Int. 2001, 60: 2337-42.PubMedCrossRef
33.
go back to reference Breidthardt T, McIntyre CW: Dialysis-induced myocardial stunning: the other side of the cardiorenal syndrome. Rev Cardiovasc Med. 2011, 12: 13-20.PubMed Breidthardt T, McIntyre CW: Dialysis-induced myocardial stunning: the other side of the cardiorenal syndrome. Rev Cardiovasc Med. 2011, 12: 13-20.PubMed
34.
go back to reference Adler J, Malone D: Early mobilization in the intensive care unit: a systematic review. Cardiopulm Phys Ther J. 2012, 23: 5-13.PubMedPubMedCentral Adler J, Malone D: Early mobilization in the intensive care unit: a systematic review. Cardiopulm Phys Ther J. 2012, 23: 5-13.PubMedPubMedCentral
Metadata
Title
Challenges and pitfalls when implementing renal replacement therapy in the ICU
Author
Ravindra L Mehta
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Critical Care / Issue Special Issue 3/2015
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc14727

Other articles of this Special Issue 3/2015

Critical Care 3/2015 Go to the issue