Renal Replacement Therapy In Critical Care

Abstract

AKI is common and 5% of the critical care population receive RRT.
There are various forms of RRT but they all remove unwanted solutes using the processes of diffusion (dialysis) and/or convection (filtration). RRT can be administered continuously or intermittently.
No single form of RRT has been shown to offer a survival benefit over the others but there are often other reasons why a particular technique may be preferable in a given situation.
There is some evidence that high volume haemofiltration may improve survival in patients with septic shock but there have been no large randomised controlled trials in this area.
Lifespan of the circuit is dependant on good quality vascular access and appropriate anticoagulation.
Pharmacokinetics while on RRT needs to be looked at on an individual basis but there are some general rules such as drugs which are protein bound are not easily removed.
60% of people receiving RRT for AKI will die during that admission but 80% of the survivors will be free from RRT one year later.