Renal replacement therapy in acute kidney injury: controversy and consensus modern renal replacement therapy

Renal replacement therapies (RRTs) represent a cornerstone in the management of severe acute kidney injury. This area of intensive care and nephrology has undergone significant improvement and evolution in recent years. Continuous RRTs have been a major focus of new technological and treatment strategies. RRT is being used increasingly in the intensive care unit, not only for renal indications but also for other organ-supportive strategies. Several aspects related to RRT are now well established, but others remain controversial. In this review, we review the available RRT modalities, covering technical and clinical aspects. We discuss several controversial issues, provide some practical recommendations, and where possible suggest a research agenda for the future.

[1]  R. Bellomo,et al.  Renal replacement therapy in acute kidney injury: controversy and consensus , 2015, Critical Care.

[2]  I. Cinel,et al.  Sepsis and Acute Kidney Injury. , 2014, Turkish journal of anaesthesiology and reanimation.

[3]  S. Scolletta,et al.  The challenges of multiple organ dysfunction syndrome and extra-corporeal circuits for drug delivery in critically ill patients. , 2014, Advanced Drug Delivery Reviews.

[4]  J. Kellum,et al.  Four phases of intravenous fluid therapy: a conceptual model. , 2014, British journal of anaesthesia.

[5]  Christopher M. Keener,et al.  Plasma inflammatory and apoptosis markers are associated with dialysis dependence and death among critically ill patients receiving renal replacement therapy. , 2014, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[6]  A. Girbes,et al.  Citrate anticoagulation versus systemic heparinisation in continuous venovenous hemofiltration in critically ill patients with acute kidney injury: a multi-center randomized clinical trial , 2014, Critical Care.

[7]  J. Roberts,et al.  The Impact of Variation in Renal Replacement Therapy Settings on Piperacillin, Meropenem, and Vancomycin Drug Clearance in the Critically Ill: An Analysis of Published Literature and Dosing Regimens* , 2014, Critical care medicine.

[8]  P. V. D. van der Voort,et al.  The furosemide stress test to predict renal function after continuous renal replacement therapy , 2014, Critical Care.

[9]  D. Roberts,et al.  The influence of acute kidney injury on antimicrobial dosing in critically ill patients: are dose reductions always necessary? , 2014, Diagnostic microbiology and infectious disease.

[10]  M. Joannidis,et al.  High-volume hemofiltration in critically ill patients: a systematic review and meta-analysis. , 2014, Minerva anestesiologica.

[11]  A. Garg,et al.  The Association Between Renal Replacement Therapy Modality and Long-Term Outcomes Among Critically Ill Adults With Acute Kidney Injury: A Retrospective Cohort Study* , 2014, Critical care medicine.

[12]  G. Remuzzi,et al.  Efficacy of coupled plasma filtration adsorption (CPFA) in patients with septic shock: A multicenter randomised controlled clinical trial , 2014, BMJ Open.

[13]  J. Vincent,et al.  A new regimen for continuous infusion of vancomycin during continuous renal replacement therapy. , 2013, The Journal of antimicrobial chemotherapy.

[14]  R. Bellomo,et al.  Phoxilium vs Hemosol-B0 for continuous renal replacement therapy in acute kidney injury. , 2013, Journal of critical care.

[15]  P. Kimmel,et al.  Development and Standardization of a Furosemide Stress Test to Predict the Severity of Acute Kidney Injury , 2013, Critical Care.

[16]  P. Magner,et al.  Phosphate balance with continuous renal replacement therapy: a simple solution. , 2013, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[17]  J. Kellum,et al.  Blood Purification and Mortality in Sepsis: A Meta-Analysis of Randomized Trials* , 2013, Critical care medicine.

[18]  R. Bellomo,et al.  Techniques of extracorporeal cytokine removal: a systematic review of human studies , 2013, Renal failure.

[19]  K. Hahnenkamp,et al.  Continuous renal replacement therapy with regional citrate anticoagulation: do we really know the details? , 2013, Current opinion in anaesthesiology.

[20]  K. Eckardt,et al.  Low-flow CO2 removal integrated into a renal-replacement circuit can reduce acidosis and decrease vasopressor requirements , 2013, Critical Care.

[21]  S. Bagshaw,et al.  High-volume versus standard-volume haemofiltration for septic shock patients with acute kidney injury (IVOIRE study): a multicentre randomized controlled trial , 2013, Intensive Care Medicine.

[22]  E. Macedo,et al.  Timing of renal replacement therapy initiation by AKIN classification system , 2013, Critical Care.

[23]  F. Herth,et al.  A novel extracorporeal CO(2) removal system: results of a pilot study of hypercapnic respiratory failure in patients with COPD. , 2013, Chest.

[24]  R. Bellomo,et al.  Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury: a systematic review and meta-analysis , 2013, Intensive Care Medicine.

[25]  Norbert Lameire,et al.  Contrast-induced acute kidney injury and renal support for acute kidney injury: a KDIGO summary (Part 2) , 2013, Critical Care.

[26]  C. Clec’h,et al.  Efficacy of renal replacement therapy in critically ill patients: a propensity analysis , 2012, Critical Care.

[27]  K. Anstrom,et al.  Ultrafiltration in decompensated heart failure with cardiorenal syndrome. , 2012, The New England journal of medicine.

[28]  R. Starling,et al.  Cardiorenal outcomes after slow continuous ultrafiltration therapy in refractory patients with advanced decompensated heart failure. , 2012, Journal of the American College of Cardiology.

[29]  K. Wille,et al.  Advances in Continuous Renal Replacement Therapy: Citrate Anticoagulation Update , 2012, Blood Purification.

[30]  L. Cohn,et al.  Point-of-Care Testing: A Prospective, Randomized Clinical Trial of Efficacy in Coagulopathic Cardiac Surgery Patients , 2012, Anesthesiology.

[31]  C. Murray,et al.  A randomized trial of catheters of different lengths to achieve right atrium versus superior vena cava placement for continuous renal replacement therapy. , 2012, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[32]  M. Zeier,et al.  Sustained low efficiency dialysis using a single-pass batch system in acute kidney injury - a randomized interventional trial: the REnal Replacement Therapy Study in Intensive Care Unit PatiEnts , 2012, Critical Care.

[33]  L. Tritapepe,et al.  Regional citrate anticoagulation in cardiac surgery patients at high risk of bleeding: a continuous veno-venous hemofiltration protocol with a low concentration citrate solution , 2012, Critical Care.

[34]  É. Azoulay,et al.  A Multicentre Study of Acute Kidney Injury in Severe Sepsis and Septic Shock: Association with Inflammatory Phenotype and HLA Genotype , 2012, PloS one.

[35]  R. Bellomo,et al.  An observational study fluid balance and patient outcomes in the randomized evaluation of normal vs. augmented level of replacement therapy trial* , 2012, Critical care medicine.

[36]  R. Bellomo,et al.  Variability of antibiotic concentrations in critically ill patients receiving continuous renal replacement therapy: A multicentre pharmacokinetic study* , 2012, Critical care medicine.

[37]  J. Herrero,et al.  Impact of non-neurological complications in severe traumatic brain injury outcome , 2012, Critical Care.

[38]  Jianghua Chen,et al.  Effect of the intensity of continuous renal replacement therapy in patients with sepsis and acute kidney injury: a single-center randomized clinical trial. , 2012, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[39]  S. Mayer,et al.  Pearls & Oy-sters: The effects of renal replacement therapy on cerebral autoregulation , 2012, Neurology.

[40]  R. Bellomo,et al.  Techniques of Extracorporeal Cytokine Removal: A Systematic Review of the Literature , 2012, Blood Purification.

[41]  C. Ronco,et al.  Diagnosis and Management of Fluid Overload in Heart Failure and Cardio-Renal Syndrome : The “ 5 B ” Approach , 2012 .

[42]  M. Darmon,et al.  Management of renal replacement therapy in ICU patients: an international survey , 2012, Intensive Care Medicine.

[43]  J. Kellum,et al.  Urinary biomarkers and renal recovery in critically ill patients with renal support. , 2011, Clinical journal of the American Society of Nephrology : CJASN.

[44]  C. Haberthür,et al.  Fluid and electrolyte management of acute traumatic brain injury using hemofiltration with regional citrate anticoagulation. , 2011, Journal of neurosurgical anesthesiology.

[45]  D. Angus,et al.  Plasma neutrophil gelatinase-associated lipocalin predicts recovery from acute kidney injury following community-acquired pneumonia , 2011, Kidney international.

[46]  J. Vincent,et al.  Pharmacokinetics of a loading dose of amikacin in septic patients undergoing continuous renal replacement therapy. , 2011, International journal of antimicrobial agents.

[47]  S. Bagshaw,et al.  A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis , 2011, Critical care.

[48]  R. Bellomo,et al.  Clinical review: Anticoagulation for continuous renal replacement therapy - heparin or citrate? , 2010, Critical care.

[49]  A. Kribben,et al.  Regional citrate versus systemic heparin for anticoagulation in critically ill patients on continuous venovenous haemofiltration: a prospective randomized multicentre trial. , 2011, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[50]  C. Ronco,et al.  Volume Assessment in Mechanically Ventilated Critical Care Patients Using Bioimpedance Vectorial Analysis, Brain Natriuretic Peptide, and Central Venous Pressure , 2010, International journal of nephrology.

[51]  R. MacLaren,et al.  Bivalirudin versus Unfractionated Heparin for Prevention of Hemofilter Occlusion During Continuous Renal Replacement Therapy , 2010, Pharmacotherapy.

[52]  J. Bakker,et al.  Neutrophil gelatinase-associated lipocalin clearance during veno-venous continuous renal replacement therapy in critically ill patients , 2010, Intensive Care Medicine.

[53]  Marcus J Schultz,et al.  Treatment of hypophosphatemia in the intensive care unit: a review , 2010, Critical care.

[54]  J. Mira,et al.  Catheter dysfunction and dialysis performance according to vascular access among 736 critically ill adults requiring renal replacement therapy: A randomized controlled study , 2010, Critical care medicine.

[55]  Yen-Hung Lin,et al.  Sustained low-efficiency dialysis versus continuous veno-venous hemofiltration for postsurgical acute renal failure. , 2010, American journal of surgery.

[56]  R. Bellomo,et al.  Cost of acute renal replacement therapy in the intensive care unit: results from The Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Study , 2010, Critical care.

[57]  D. Angus,et al.  Acute kidney injury in non-severe pneumonia is associated with an increased immune response and lower survival. , 2010, Kidney international.

[58]  M. Mathru Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients , 2010 .

[59]  K. Tanjoh,et al.  Hemoperfusion With an Immobilized Polymyxin B Fiber Column Decreases Macrophage and Monocyte Activity , 2009, Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy.

[60]  R. Bellomo,et al.  Vascular access for continuous renal replacement therapy , 2009 .

[61]  M. Rosner,et al.  Acute kidney injury. , 2009, Current drug targets.

[62]  R. Bellomo,et al.  Discontinuation of continuous renal replacement therapy: A post hoc analysis of a prospective multicenter observational study* , 2009, Critical care medicine.

[63]  D. Fliser,et al.  The Hannover Dialysis Outcome study: comparison of standard versus intensified extended dialysis for treatment of patients with acute kidney injury in the intensive care unit. , 2009, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[64]  Brad E. Zacharia,et al.  Renal Dysfunction as an Independent Predictor of Outcome After Aneurysmal Subarachnoid Hemorrhage: A Single-Center Cohort Study , 2009, Stroke.

[65]  M. Antonelli,et al.  Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized controlled trial. , 2009, JAMA.

[66]  E. Vicaut,et al.  Impact of continuous venovenous hemofiltration on organ failure during the early phase of severe sepsis: A randomized controlled trial* , 2009, Critical care medicine.

[67]  G. Navis,et al.  Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease. , 2009, Journal of the American College of Cardiology.

[68]  Gary S Francis,et al.  Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. , 2009, Journal of the American College of Cardiology.

[69]  J. Wester,et al.  Citrate anticoagulation for continuous venovenous hemofiltration* , 2009, Critical care medicine.

[70]  M. Kuiper,et al.  Furosemide does not improve renal recovery after hemofiltration for acute renal failure in critically ill patients: A double blind randomized controlled trial* , 2009, Critical care medicine.

[71]  M. Böhm,et al.  Argatroban for anticoagulation in continuous renal replacement therapy* , 2009, Critical care medicine.

[72]  R. Ward Principles of Extracorporeal Circulation , 2009 .

[73]  P. Peduzzi,et al.  Intensity of renal support in critically ill patients with acute kidney injury. , 2008, The New England journal of medicine.

[74]  M. Mattson,et al.  Acute kidney injury leads to inflammation and functional changes in the brain. , 2008, Journal of the American Society of Nephrology : JASN.

[75]  Didier Payen,et al.  A positive fluid balance is associated with a worse outcome in patients with acute renal failure , 2008, Critical care.

[76]  B. Souweine,et al.  Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. , 2008, JAMA.

[77]  L. Mascia,et al.  Polymyxin-B hemoperfusion inactivates circulating proapoptotic factors , 2008, Intensive Care Medicine.

[78]  Imad F. Btaiche,et al.  Amino Acid Requirements in Critically Ill Patients with Acute Kidney Injury Treated with Continuous Renal Replacement Therapy , 2008, Pharmacotherapy.

[79]  S. Hart,et al.  Choice of anticoagulant critically affects measurement of circulating platelet-leukocyte complexes. , 2007, Arteriosclerosis, thrombosis, and vascular biology.

[80]  R. Bellomo,et al.  High Cut-off Point Membranes in Septic Acute Renal Failure: A Systematic Review , 2007, The International journal of artificial organs.

[81]  J. Hofstra,et al.  Pharmacokinetics and pharmacodynamics of danaparoid during continuous venovenous hemofiltration: a pilot study , 2007, Critical care.

[82]  John A Kellum,et al.  Understanding the inflammatory cytokine response in pneumonia and sepsis: results of the Genetic and Inflammatory Markers of Sepsis (GenIMS) Study. , 2007, Archives of internal medicine.

[83]  H. O. Oudemans-van Straaten,et al.  Clinical review: Patency of the circuit in continuous renal replacement therapy , 2007, Critical care.

[84]  H. Ulmer,et al.  Enoxaparin vs. unfractionated heparin for anticoagulation during continuous veno-venous hemofiltration: a randomized controlled crossover study , 2007, Intensive Care Medicine.

[85]  R. Bellomo,et al.  Effectiveness of polymyxin B-immobilized fiber column in sepsis: a systematic review , 2007, Critical care.

[86]  A. Greinacher,et al.  Heparin-induced thrombocytopenia in intensive care patients , 2007, Critical care medicine.

[87]  M. Guglin,et al.  Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. , 2007, Journal of the American College of Cardiology.

[88]  I. Douglas,et al.  Acute renal failure after bilateral nephrectomy is associated with cytokine-mediated pulmonary injury. , 2007, Journal of the American Society of Nephrology : JASN.

[89]  Yen-Hung Lin,et al.  Risk factors of early redialysis after weaning from postoperative acute renal replacement therapy , 2007, Intensive Care Medicine.

[90]  R. Richardson,et al.  Sustained low-efficiency dialysis in the ICU: cost, anticoagulation, and solute removal. , 2006, Kidney international.

[91]  T. Kiser,et al.  Evaluation of Bivalirudin Treatment for Heparin‐Induced Thrombocytopenia in Critically Ill Patients with Hepatic and/or Renal Dysfunction , 2006, Pharmacotherapy.

[92]  P. Charbonneau,et al.  Antithrombin supplementation for anticoagulation during continuous hemofiltration in critically ill patients with septic shock: a case-control study , 2006, Critical care.

[93]  C. Schalkwijk,et al.  Citrate anticoagulation abolishes degranulation of polymorphonuclear cells and platelets and reduces oxidative stress during haemodialysis. , 2006, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[94]  J. Wester,et al.  Anticoagulation strategies in continuous renal replacement therapy: can the choice be evidence based? , 2006, Intensive Care Medicine.

[95]  C. Ronco,et al.  Pre- versus Post-Dilution CVVH , 2005, Blood Purification.

[96]  Qing Ma,et al.  Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery , 2005, The Lancet.

[97]  C. Ronco,et al.  A new machine for continuous renal replacement therapy: from development to clinical testing , 2005, Expert review of medical devices.

[98]  G. Mombelli,et al.  The favorable effect of regional citrate anticoagulation on interleukin-1beta release is dissociated from both coagulation and complement activation. , 2004, Journal of nephrology.

[99]  R. Bellomo,et al.  Blood flow reductions during continuous renal replacement therapy and circuit life , 2004, Intensive Care Medicine.

[100]  D. Fliser,et al.  Efficacy and cardiovascular tolerability of extended dialysis in critically ill patients: a randomized controlled study. , 2004, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[101]  David W. Johnson,et al.  Cost of acute renal failure requiring dialysis in the intensive care unit: Clinical and resource implications of renal recovery* , 2003, Critical care medicine.

[102]  J. Plummer,et al.  Conventional coagulation and thromboelastograph parameters and longevity of continuous renal replacement circuits , 2002, Intensive Care Medicine.

[103]  Rinaldo Bellomo,et al.  A pilot study of coupled plasma filtration with adsorption in septic shock* , 2002, Critical care medicine.

[104]  M. Greaves,et al.  Limitations of the Laboratory Monitoring of Heparin Therapy , 2002, Thrombosis and Haemostasis.

[105]  E. Lindhoff‐Last,et al.  Use of a Low-Molecular-Weight Heparinoid (Danaparoid Sodium) for Continuous Renal Replacement Therapy in Intensive Care Patients , 2001, Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis.

[106]  E. Ohman,et al.  Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. , 2001, Chest.

[107]  G. Hanique,et al.  Prospective evaluation of short-term, high-volume isovolemic hemofiltration on the hemodynamic course and outcome in patients with intractable circulatory failure resulting from septic shock , 2000, Critical care medicine.

[108]  T. Depner,et al.  Extended daily dialysis: A new approach to renal replacement for acute renal failure in the intensive care unit. , 2000, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[109]  Rinaldo Bellomo,et al.  Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial , 2000, The Lancet.

[110]  R. Bellomo,et al.  Brain density changes during renal replacement in critically ill patients with acute renal failure. Continuous hemofiltration versus intermittent hemodialysis. , 1999, Journal of nephrology.

[111]  P. Chan,et al.  Protection of astrocytes by fructose 1,6-bisphosphate and citrate ameliorates neuronal injury under hypoxic conditions , 1996, Brain Research.

[112]  R. Westendorp,et al.  Heparin use in continuous renal replacement procedures: the struggle between filter coagulation and patient hemorrhage. , 1996, Journal of the American Society of Nephrology : JASN.

[113]  A. Davenport,et al.  Early changes in intracranial pressure during haemofiltration treatment in patients with grade 4 hepatic encephalopathy and acute oliguric renal failure. , 1990, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[114]  P. Suter,et al.  Urinary Antidiuretic Hormone Excretion during Mechanical Ventilation and Weaning in Man , 1980, Anesthesiology.