Critical Care Research and Practice / 2019 / Article / Tab 3

Review Article

Renal Replacement Therapy in the Critical Care Setting

Table 3

17th Acute Disease Quality Initiative (ADQI) consensus on patient selection and timing of CRRT (2016) [32].

Consensus statement 1.1: Acute RRT should be considered when metabolic and fluid demands exceed total kidney capacity
Consensus statement 1.2: Demand for kidney function is determined by nonrenal comorbidities, the severity of the acute disease, and solute and fluid burden.
Consensus statement 1.3: Total kidney function is measured using a variety of different methods. Changes in kidney function and duration of kidney dysfunction can be anticipated by markers of kidney damage.
Consensus statement 1.4: The demand-capacity imbalance is dynamic and should be evaluated regularly
Consensus statement 1.5: For patients requiring multiple types of organ support, decisions about initiating or withholding RRT should be considered together with other therapies
Consensus statement 1.6: Once the decision to initiate RRT has been made, the therapy should be started as soon as possible, typically within less than 3 h.
Consensus statement 2.1: Selection of RRT modality depends on the capability/availability of the technology, its inherited risks, and the current needs of the patient
Consensus statement 2.2: Continuous types of RRT are recommended in situations where shifts in fluid balance and metabolic fluctuations are poorly tolerated. Intermittent and prolonged intermittent types of RRT have a role in situations where rehabilitation or mobilisation is the priority, and fluid and metabolic fluctuations can be tolerated
Consensus statement 2.3: Availability of technologies is determined by local regulations, local resources, including staff and their training/experience and laboratory support, and financial constraints. The choice of technologies that should be made available must balance these issues.
Consensus statement 3.1: In situations where other extracorporeal therapies are required, continuous RRT is recommended and integrated systems are preferred over parallel systems.
Consensus statement 4.1: Transition of modalities should be considered if the demand-capacity imbalance or treatment priorities have changed and can be met better by an alternative technique.
Consensus statement 5.1: RRT should be discontinued if kidney function has recovered sufficiently to reduce the demand-capacity imbalance (current and expected) to acceptable levels or the overall goals of treatment have changed.
Consensus statement 5.2: To determine sustained recovery of kidney function, we recommend monitoring of urine output and SCr during RRT.
Consensus statement 5.3: For patients requiring multiple types of organ support, decisions about withdrawing RRT should be considered together with other therapies