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Critical Care Research and Practice
Volume 2019, Article ID 6948710, 11 pages
https://doi.org/10.1155/2019/6948710
Review Article

Renal Replacement Therapy in the Critical Care Setting

1MB BCh BAO MRCPI MRCP(UK) PGDip (ClinEd), Holder of European Certificate in Nephrology, University Hospital Galway, Galway, Ireland
2MB BCh BAO MRCPI, Specialist Registrar in Nephrology, University Hospital Galway, Galway, Ireland
3MB BCh FRCPI PhD (NUI), Consultant Nephrologist, University Hospital Galway, Galway, Ireland

Correspondence should be addressed to Adeel Rafi Ahmed; moc.liamg@demha.r.leeda

Received 30 March 2019; Accepted 29 May 2019; Published 16 July 2019

Academic Editor: Timothy E. Albertson

Copyright © 2019 Adeel Rafi Ahmed et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Renal replacement therapy (RRT) is frequently required to manage critically ill patients with acute kidney injury (AKI). There is limited evidence to support the current practice of RRT in intensive care units (ICUs). Recently published randomized control trials (RCTs) have further questioned our understanding of RRT in critical care. The optimal timing and dosing continues to be debatable; however, current evidence suggests delayed strategy with less intensive dosing when utilising RRT. Various modes of RRT are complementary to each other with no definite benefits to mortality or renal function preservation. Choice of anticoagulation remains regional citrate anticoagulation in continuous renal replacement therapy (CRRT) with lower bleeding risk when compared with heparin. RRT can be used to support resistant cardiac failure, but evolving therapies such as haemoperfusion are currently not recommended in sepsis.