title: The future of critical care: renal support in 2027.
abstract: Since its inception four decades ago, both the clinical and technologic aspects of continuous renal replacement therapy (CRRT) have evolved substantially. Devices now specifically designed for critically ill patients with acute kidney injury are widely available and the clinical challenges associated with treating this complex patient population continue to be addressed. However, several important questions remain unanswered, leaving doubts in the minds of many clinicians about therapy prescription/delivery and patient management. Specifically, questions surrounding therapy dosing, timing of initiation and termination, fluid management, anticoagulation, drug dosing, and data analytics may lead to inconsistent delivery of CRRT and even reluctance to prescribe it. In this review, we discuss current limitations of CRRT and potential solutions over the next decade from both a patient management and a technology perspective. We also address the issue of sustainability for CRRT and related therapies beyond 2027 and raise several points for consideration.
authors.affiliation: School of Chemical Engineering, Purdue University, 480 Stadium Mall Drive; FRNY 1051, West Lafayette, IN, 47907, USA. clarkw@purdue.edu.
authors.forename: William R
authors.initials: WR
authors.lastname: Clark
authors.affiliation: International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Neri
authors.affiliation: International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Garzotto
authors.affiliation: Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Zaccaria
authors.initials: Z
authors.lastname: Ricci
authors.affiliation: Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldstein
authors.affiliation: Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Institute of Kidney Disease and Dialysis, Shanghai Quality Control Center for Dialysis, Shanghai, China.
authors.forename: Xiaoqiang
authors.initials: X
authors.lastname: Ding
authors.affiliation: Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Institute of Kidney Disease and Dialysis, Shanghai Quality Control Center for Dialysis, Shanghai, China.
authors.forename: Jiarui
authors.initials: J
authors.lastname: Xu
authors.affiliation: International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy.|Department of Nephrology, San Bortolo Hospital, Vicenza, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy; D005440:Fluid Therapy / Q000379:methods; D005544:Forecasting / Q000379:methods*; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D006435:Renal Dialysis / Q000379:methods; D017582:Renal Replacement Therapy / Q000295:instrumentation / Q000379:methods* / Q000639:trends*