Acute kidney injury and renal replacement therapy in the intensive care unit.
BACKGROUND
Renal replacement therapy (RRT) is now offered as a routine treatment in most intensive care units (ICU) in the UK for patients suffering from acute kidney injury (AKI). It is important for all ICU staff to understand the underlying principles of the available therapeutic options and the possible complications thereof.


OBJECTIVE
The objective of this review was to provide an accessible theoretical and practical update on the management of RRT. In addition to a detailed discussion of the underlying principles and indications for the various modes of RRT, we will discuss the assessment of kidney function, possible complications and anticoagulation during RRT, following a review of the current literature.


METHODS
Pubmed, Medline and the Cumulative Index to Nursing and Allied Health Literature were searched using the keywords renal function, RRT, dialysis, renal failure kidney injury, together with intensive care, intensive therapy and critical care. We included only studies published in English from 1998 to 2008 and from these identified and included additional publications. The 12 most relevant publications are referenced in this review.


CONCLUSIONS
AKI is associated with increased mortality in ICU, and RRT should be considered early in the disease process. Continuous haemofiltration is the most common modality of treatment in this group of patients, and a detailed knowledge of the management of such patients is required.
Faber
Peter
P
Aberdeen Royal Infirmary, Aberdeen, UK.
Klein
Andrew A
AA
D058186:Acute Kidney Injury / Q000628:therapy*; D001166:Arteriovenous Shunt, Surgical; D003404:Creatinine / Q000378:metabolism; D003422:Critical Care; D006440:Hemofiltration; D006801:Humans; D007362:Intensive Care Units; D008657:Metabolic Clearance Rate; D006435:Renal Dialysis; D017582:Renal Replacement Therapy / Q000009:adverse effects / Q000379:methods
D003404:Creatinine