Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 24 , ISSUE S3 ( April, 2020 ) > List of Articles

INVITED ARTICLE

Solute and Volume Dosing during Kidney Replacement Therapy in Critically Ill Patients with Acute Kidney Injury

Raghavan Murugan

Keywords : Dosing, Kidney replacement therapy, Solute control, Volume control

Citation Information : Murugan R. Solute and Volume Dosing during Kidney Replacement Therapy in Critically Ill Patients with Acute Kidney Injury. Indian J Crit Care Med 2020; 24 (S3):107-111.

DOI: 10.5005/jp-journals-10071-23391

License: CC BY-NC 4.0

Published Online: 25-08-2015

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Among critically ill patients with severe acute kidney injury either continuous kidney replacement therapy (CKRT) or intermittent hemodialysis (IHD) can be performed to provide optimal solute and volume control. The modality of KRT should be chosen based on the needs of the patient, hemodynamic status, clinician expertise, and resource available under a particular setting and consideration of costs. Evidence from high-quality randomized trials suggests that an effluent flow rate of 25 mL/kg/hour per day using CKRT and Kt/V of 1.3 per session of IHD provide optimal solute control. For volume dosing, the net ultrafiltration (UFNET) rate should be prescribed based on patient body weight in milliliters per kilogram per hour, with close monitoring of patient hemodynamics and fluid balance. Emerging evidence from observational studies suggests a “J”-shaped association between UFNET rate and outcomes with both faster and slower UFNET rates being associated with increased mortality compared with moderate UFNET rates. Thus, randomized trials are required to determine optimal UFNET rates in critically ill patients.


HTML PDF Share
  1. Kidney Disease: Improving Global Outcomes (KDIGO). Clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012;2(1):1–138. DOI: 10.1038/kisup.2012.1.
  2. Clark WR, Ronco C. Renal replacement therapy in acute renal failure: solute removal mechanisms and dose quantification. Kidney Int Suppl 1998;66:S133–S137.
  3. RENAL RRT Investigators. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med 2009;361(17):1627–1638. DOI: 10.1056/NEJMoa0902413.
  4. Acute renal failure Trial Network (ATN) Investigators. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med 2008;359(1):7–20. DOI: 10.1056/NEJMoa0802639.
  5. 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(4):246–250. DOI: 10.1053/jcrc.2002.36757.
  6. Vesconi S, Cruz DN, Fumagalli R, Kindgen-Milles D, Monti G, Marinho A, et al. Delivered dose of renal replacement therapy and mortality in critically ill patients with acute kidney injury. Crit Care 2009;13(2):R57. DOI: 10.1186/cc7784.
  7. Bagshaw SM, Chakravarthi MR, Ricci Z, Tolwani A, Neri M, De Rosa S, et al. Precision continuous renal replacement therapy and solute control. Blood Purif 2016;42(3):238–247. DOI: 10.1159/000448507.
  8. Friedrich JO, Wald R, Bagshaw SM, Burns KE, Adhikari NK. Hemofiltration compared to hemodialysis for acute kidney injury: systematic review and meta-analysis. Crit Care 2012;16(4):R146. DOI: 10.1186/cc11458.
  9. Neri M, Villa G, Garzotto F, Bagshaw S, Bellomo R, Cerda J, et al. Nomenclature for renal replacement therapy in acute kidney injury: basic principles. Crit Care 2016;20(1):318. DOI: 10.1186/s13054-016-1489-9.
  10. Pirkle JL, Comeau ME, Langefeld CD, Russell GB, Balderston SS, Freedman BI, et al. Effects of weight-based ultrafiltration rate limits on intradialytic hypotension in hemodialysis. Hemodial Int 2018;22:(2):270–278. DOI: 10.1111/hdi.12578.
  11. Murugan R, Balakumar V, Kerti SJ, Priyanka P, Chang CCH, Clermont G, et al. Net ultrafiltration intensity and mortality in critically ill patients with fluid overload. Crit Care 2018;22(1):223. DOI: 10.1186/s13054-018-2163-1.
  12. Murugan R, Kerti SJ, Chang C-CH, Gallagher M, Clermont G, Palevsky PM, et al. Association of net ultrafiltration rate with mortality among critically ill adults with acute kidney injury receiving continuous venovenous hemodiafiltration: A secondary analysis of the randomized evaluation of normal vs augmented level (RENAL) of renal replacement therapy trial. JAMA Netw Open 2019;2(6):e195418. DOI: 10.1001/jamanetworkopen.2019.5418.
  13. Flythe JE, Curhan GC, Brunelli SM. Shorter length dialysis sessions are associated with increased mortality, independent of body weight. Kidney Int 2013;83(1):104–113. DOI: 10.1038/ki.2012.346.
  14. Flythe JE, Kimmel SE, Brunelli SM. Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality. Kidney Int 2011;79(2):250–257. DOI: 10.1038/ki.2010.383.
  15. Kim TW, Chang TI, Kim TH, Chou JA, Soohoo M, Ravel VA, et al. Association of ultrafiltration rate with mortality in incident hemodialysis patients. Nephron 2018;139(1):13–22. DOI: 10.1159/000486323.
  16. Movilli E, Gaggia P, Zubani R, Camerini C, Vizzardi V, Parrinello G, et al. Association between high ultrafiltration rates and mortality in uraemic patients on regular haemodialysis. A 5-year prospective observational multicentre study. Nephrol Dial Transplant 2007;22(12):3547–3552. DOI: 10.1093/ndt/gfm466.
  17. Saran R, Bragg-Gresham JL, Levin NW, Twardowski ZJ, Wizemann V, Saito A, et al. Longer treatment time and slower ultrafiltration in hemodialysis: associations with reduced mortality in the DOPPS. Kidney Int 2006;69(7):1222–1228. DOI: 10.1038/sj.ki.5000186.
  18. Kramer H, Yee J, Weiner DE, Bansal V, Choi MJ, Brereton L, et al. Ultrafiltration rate thresholds in maintenance hemodialysis: an NKF-KDOQI controversies report. Am J Kidney Dis 2016;68(4):522–532. DOI: 10.1053/j.ajkd.2016.06.010.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.