Renal replacement therapy (RRT) for acute kidney injury (AKI) patients in an intensive care unit (ICU) presents unique problems of providing biochemical and fluid removal in patients with unstable circulations, inotropes, and increased capillary permeability. Although no individual modality has been shown to confer a mortality benefit, it is assumed that continuous therapies like peritoneal dialysis (PD) and venovenous hemofiltration or hemodiafiltration may be better tolerated by the patient with hemodynamic instability, raised intracranial pressure (ICP), and liver failure. An individual patient may require more than one treatment in the course of his/her illness. The therapies offered may reflect available resources, local expertise, and cost constraints.
KDIGO Clinical Practice Guideline for Acute Kidney Injury, Kid Int; March 2012; 2(S1). pp. 1–138.
Vanmassenhove J, Kielstein J, Jörres A, Biesen WV. Management of patients at risk of acute kidney injury. Lancet 2017;389(10084):2139–2151. DOI: 10.1016/S0140-6736(17)31329-6.
Annigeri RA, Ostermann M, Tolwani A, Vazquez-Rangel A, Ponce D, Bagga A, et al. Renal support for acute kidney injury in the developing world. Kidney Int Rep 2017;2(4):559–578. DOI: 10.1016/j.ekir.2017.04.006.
Ostermann M, Joannidis M, Pani A, Floris M, De Rosa S, Kellum JA, et al. Patient selection and timing of continuous renal replacement therapy. Blood Purif 2016;42(3):224–237. DOI: 10.1159/000448506.
Marshall MR, Golper TA, Shaver MJ, Alam MG, Chatoth DK. Sustained low-efficiency dialysis for critically ill patients requiring renal replacement therapy. Kidney Int 2001;60(2):777–785. DOI: 10.1046/j.1523-1755.2001.060002777.x.
Raina R, Chauvin AM, Bunchman T, Askenazi D, Deep A, Ensley MJ, et al. Treatment of AKI in developing and developed countries: An international survey of pediatric dialysis modalities. PLoS ONE 2017(5):1–9. DOI: 10.1371/journal.pone.0178233.
Schwenger V, Weigand MA, Hoffmann O, Dikow R, Kihm LP, Seckinger J, et al. Sustained low efficiency dialysis using a single-pass batch system in acute kidney injury - a randomized interventional trial: the renal replacement therapy study in intensive care unit patients. Crit Care 2012;16(4):R140. DOI: 10.1186/cc11445.
Kitchlu A, Adhikari N, Burns KEA, Friedrich JO, Garg AX, Klein D, et al. Outcomes of sustained low efficiency dialysis versus continuous renal replacement therapy in critically ill adults with acute kidney injury: a cohort study. BMC Nephrol 2015;16(1):127. DOI: 10.1186/s12882-015-0123-4.
Kovacs B, Sullivan K, Hiremath S, Patel R. Effect of sustained low efficient dialysis versus continuous renal replacement therapy on renal recovery after acute kidney injury in the intensive care unit: a systematic review and meta-analysis. Nephrology 2017;22(5):343–353. DOI: 10.1111/nep.13009.
Wu VC, Huang TM, Shiao CC, Lai CF, Tsai PR, Wang WJ, et al. NSARF Group. - The hemodynamic effects during sustained low-efficiency dialysis versus continuous veno-venous hemofiltration for uremic patients with brain hemorrhage: a crossover study. J Neurosurg 2013;119(5):1288–1295. DOI: 10.3171/2013.4.JNS122102.
Phu NH, Hien TT, Mai NT, Chau TT, Chuong LV, Loc PP, et al. Hemofiltration and peritoneal dialysis in infection-associated acute renal failure in Vietnam. N Engl J Med 2002;347(12):895–902. DOI: 10.1056/NEJMoa020074.
Chionh CY, Soni SS, Finkelstein FO, Ronco C, Cruz DN. Use of peritoneal dialysis in AKI: a systematic review. Clin J Am Soc Nephrol 2013;8(10):1649–1660. DOI: 10.2215/CJN.01540213.
ISN Guidelines on Hemodialysis Units; Indian Journal of Nephrology | Volume 30 | Supplement 1 January 2020.
