The dark side of high-intensity renal replacement therapy of acute kidney injury in critically ill patients.
The impact of intensity or dose of renal replacement therapy (RRT) on outcome of critically ill patients has been a matter of controversy. Most definitions of an adequate dose of acute RRT are based on urea removal, while ignoring other crucial aspects of RRT adequacy in acute kidney injury (AKI). Although some clinical trials have found an improvement in survival with higher doses of intermittent hemodialysis or continuous RRT, results have not been consistent across all studies. The largest trials suggest that there is no additional survival benefit with doses of 35-45 ml/kg/h (CRRT) or daily intermittent hemodialysis. On the other hand, high-intensity treatment may cause life-threatening complications and thereby counteract the benefits of higher small-solute clearance. One important area for future investigations is the need to characterize the potential harm of high-dose RRT for AKI in critically ill patients.
Schiffl
Helmut
H
KfH Nierenzentrum München-Laim, Department of Internal Medicine-Campus Innenstadt, University of Munich, Elsenheimerstr. 63, 80687, Munchen, Germany. hschiffl@hotmail.com
D058186:Acute Kidney Injury / Q000628:therapy*; D016638:Critical Illness; D006801:Humans; D017582:Renal Replacement Therapy / Q000009:adverse effects / Q000379:methods*
Curr Opin Crit Care. 2006 Dec;12(6):538-43
17077683
Am J Respir Crit Care Med. 2000 Jul;162(1):197-202
10903241
Int J Artif Organs. 2008 Jan;31(1):3-5
18286449
N Engl J Med. 2008 Jul 3;359(1):7-20
18492867
NDT Plus. 2010 Feb;3(1):1-7
25949400
Minerva Urol Nefrol. 2009 Sep;61(3):159-69
19773720
Artif Organs. 2003 Sep;27(9):815-20
12940904
N Engl J Med. 2009 Oct 22;361(17):1627-38
19846848
J Crit Care. 2002 Dec;17(4):246-50
12501152
Crit Care. 2008;12(3):R74
18533029
Am J Med. 2005 Aug;118(8):827-32
16084171
Crit Care Med. 2009 Mar;37(3):803-10
19237881
Crit Care Med. 2002 Sep;30(9):2051-8
12352040
Nephron Clin Pract. 2007;107(4):c163-9
17975323
Am J Kidney Dis. 1998 Nov;32(5):731-8
9820441
Kidney Int. 2006 Oct;70(7):1312-7
16850022
Blood Purif. 2010;29(3):259-63
20016150
Clin J Am Soc Nephrol. 2007 Jul;2(4):623-30
17699474
J Am Soc Nephrol. 2004 Jun;15(6):1597-605
15153571
Curr Opin Crit Care. 2007 Dec;13(6):635-7
17975382
Adv Chronic Kidney Dis. 2008 Jul;15(3):297-307
18565480
N Engl J Med. 2002 Jan 31;346(5):305-10
11821506
Nephrol Dial Transplant. 2003 May;18(5):961-6
12686672
Artif Organs. 2003 Sep;27(9):808-14
12940903
Clin Nephrol. 1986 May;25(5):249-55
3720035
Semin Dial. 2009 Mar-Apr;22(2):155-9
19426420
Lancet. 2000 Jul 1;356(9223):26-30
10892761
Int Urol Nephrol. 2010 Mar;42(1):259-71
19707882
Nephrol Dial Transplant. 2001 Feb;16(2):320-7
11158407
J Am Soc Nephrol. 2008 Jun;19(6):1233-8
18337480
Crit Care. 2009;13(2):R57
19368724
Semin Dial. 2007 May-Jun;20(3):220-8
17555488
Crit Care Med. 2002 Oct;30(10):2205-11
12394945
Lancet. 1994 Aug 27;344(8922):570-2
7914959
N Engl J Med. 2008 Oct 30;359(18):1960; author reply 1961-2
18979570
Am J Kidney Dis. 1999 Sep;34(3):486-92
10469859
Nephrology (Carlton). 2006 Jun;11(3):181-91
16756629
Crit Care. 2007;11(6):232
18001499
Kidney Int. 2009 Aug;76(4):422-7
19436332