title: Validity of low-efficacy continuous renal replacement therapy in critically ill patients.
abstract: The 1980s saw the use of continuous arteriovenous hemofiltration whose intensity hemofiltration rate was only 3 or 4 mL kg⁻¹ h⁻¹. With the installation of a blood pump, this dose went up to 8 or 10 mL kg⁻¹ h⁻1, and continued to increase, reaching about 20 mL kg⁻¹ h⁻¹ by the year 2000. Some studies found that a higher dose could be beneficial, and the world rapidly followed the trend, increasing the dose up to 35 mL kg⁻¹ h⁻¹. Then, two randomized control trials, namely the VA/NIH Acute Renal Failure Trial Network study and the RENAL study, came along in succession which changed the Kidney Disease: Improving Global Outcomes (KDIGO) recommendation to 20 to 25 mL kg⁻¹ h⁻¹. However, no good evidence exists to support this. Our recent multicenter retrospective studies from the JSEPTIC CRRT database show that the Japanese continuous renal replacement therapy dose of (14.3 mL kg⁻¹ h⁻¹) does not seem to have worse outcomes when compared with a higher dose.
authors.affiliation: Department of Nephrology, Inagi Municipal Hospital, Tokyo, Japan. hirookawarazaki@yahoo.co.jp.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Kawarazaki
authors.forename: Shigehiko
authors.initials: S
authors.lastname: Uchino
mesh_terms: D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D006440:Hemofiltration / Q000009:adverse effects / Q000379:methods; D006801:Humans; D017582:Renal Replacement Therapy / Q000009:adverse effects / Q000379:methods*; D015203:Reproducibility of Results
keywords: CRRT intensity; acute kidney injury; critically ill