Zaccaria Ricci1, Claudio Ronco. 1. Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy. z.ricci@libero.it
Abstract
PURPOSE OF REVIEW: In the past 3 years substantial progress has been made in the field of renal replacement therapy (RRT) for critically ill patients. RECENT FINDINGS: Two important multicenter randomized clinical trials have been recently published and extensively discussed: the randomized evaluation of normal versus augmented level (RENAL) replacement therapy study and the VA/NIH Acute Renal Failure Trial Network (ATN) study. The RENAL and ATN studies were designed to compare 'normal' or 'less intensive' renal support to an 'augmented' or 'intensive' therapy: both studies showed no benefit in outcomes by increases in intensity of RRT dose. The definition of 'normal dose' is now recommended in a range of 20-30 ml/kg per h for continuous therapies and/or thrice weekly intermittent hemodialysis. On the contrary, the complex issue of RRT optimal timing still remains uncertain and controversial. SUMMARY: Wide variations in clinical practice still require RRT for critically ill patients to be optimized. The ideal prescription does not exist; however, continuous hemofiltration at a dose of 30 ml/kg/h meets many requirements of optimal care. In order to shed some light in the issue of RRT timing, furthermore, in the near future a standardized and clinically relevant definition of 'early' RRT should be provided. Great expectations currently rely on the utilization of acute kidney injury severity classifications and on new biomarkers of renal function.
PURPOSE OF REVIEW: In the past 3 years substantial progress has been made in the field of renal replacement therapy (RRT) for critically illpatients. RECENT FINDINGS: Two important multicenter randomized clinical trials have been recently published and extensively discussed: the randomized evaluation of normal versus augmented level (RENAL) replacement therapy study and the VA/NIH Acute Renal Failure Trial Network (ATN) study. The RENAL and ATN studies were designed to compare 'normal' or 'less intensive' renal support to an 'augmented' or 'intensive' therapy: both studies showed no benefit in outcomes by increases in intensity of RRT dose. The definition of 'normal dose' is now recommended in a range of 20-30 ml/kg per h for continuous therapies and/or thrice weekly intermittent hemodialysis. On the contrary, the complex issue of RRT optimal timing still remains uncertain and controversial. SUMMARY: Wide variations in clinical practice still require RRT for critically illpatients to be optimized. The ideal prescription does not exist; however, continuous hemofiltration at a dose of 30 ml/kg/h meets many requirements of optimal care. In order to shed some light in the issue of RRT timing, furthermore, in the near future a standardized and clinically relevant definition of 'early' RRT should be provided. Great expectations currently rely on the utilization of acute kidney injury severity classifications and on new biomarkers of renal function.
Authors: Joerg C Schefold; Stephan von Haehling; Rene Pschowski; Thorsten Bender; Cathrin Berkmann; Sophie Briegel; Dietrich Hasper; Achim Jörres Journal: Crit Care Date: 2014-01-10 Impact factor: 9.097
Authors: Christoph Sponholz; Ole Bayer; Björn Kabisch; Karin Wurm; Katharina Ebert; Michael Bauer; Andreas Kortgen Journal: ScientificWorldJournal Date: 2014-12-09