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Valdenebro M, Martín-Rodríguez L, Tarragón B, et al. Una visión nefrológica del tratamiento sustitutivo renal en el paciente crítico con fracaso renal agudo: horizonte 2020. Renal replacement therapy in critically ill patients with acute kidney injury: 2020 nephrologist's perspective. Nefrologia (Engl Ed). 2020;41(2):102-114doi: 10.1016/j.nefro.2020.07.016.
Valdenebro, M., Martín-Rodríguez, L., Tarragón, B., Sánchez-Briales, P., & Portolés, J. (2021). Una visión nefrológica del tratamiento sustitutivo renal en el paciente crítico con fracaso renal agudo: horizonte 2020. Renal replacement therapy in critically ill patients with acute kidney injury: 2020 nephrologist's perspective. Nefrologia, 41(2), 102-114. https://doi.org/10.1016/j.nefro.2020.07.016
Valdenebro, María, et al. "Una visión nefrológica del tratamiento sustitutivo renal en el paciente crítico con fracaso renal agudo: horizonte 2020." Renal replacement therapy in critically ill patients with acute kidney injury: 2020 nephrologist's perspective. Nefrologia vol. 41,2 (2021): 102-114. doi: https://doi.org/10.1016/j.nefro.2020.07.016
Valdenebro M, Martín-Rodríguez L, Tarragón B, Sánchez-Briales P, Portolés J. Una visión nefrológica del tratamiento sustitutivo renal en el paciente crítico con fracaso renal agudo: horizonte 2020. Renal replacement therapy in critically ill patients with acute kidney injury: 2020 nephrologist's perspective. Nefrologia (Engl Ed). 2021 Mar-Apr;41(2):102-114. doi: 10.1016/j.nefro.2020.07.016. Epub 2020 Dec 25. Spanish. PMID: 33371962.
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Nefrologia (Engl Ed). 2021 Mar-Apr;41(2):102-114. doi: 10.1016/j.nefro.2020.07.016. Epub 2020 Dec 25.

Renal replacement therapy in critically ill patients with acute kidney injury: 2020 nephrologist's perspective.

Nefrologia

[Article in Spanish]
María Valdenebro, Leyre Martín-Rodríguez, Blanca Tarragón, Paula Sánchez-Briales, Jose Portolés

Affiliations

  1. Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España; RedinRen RETIC ISCIII 16/009/009.
  2. Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
  3. Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España; RedinRen RETIC ISCIII 16/009/009. Electronic address: [email protected].

PMID: 33371962 DOI: 10.1016/j.nefro.2020.07.016

Abstract

Renal replacement therapies (RRT) as support for acute kidney injury in critically ill patients have become a routine and essential practice in their management, resulting in the widespread use of various techniques among these patients, such as intermittent hemodialysis (IHD), extended hemodialysis and continuous RRT (CRRT). In this review we aim to summarize current evidence of indication, choice of modality, timing of initiation, dosing and technical aspects of RRT. We carried out a narrative review based on guidelines, consensus documents by main working groups and the latest relevant clinical trials on RRT in the critically ill. We did not find enough evidence of any RRT modality having superior benefits in terms of patient survival, length of intensive care unit/hospital stay or renal outcomes among critically ill patients, in spite of optimization of clinical indication, modality, timing of initiation and intensity of initial therapy. This is still a controverted matter, since only early start of high-flux CRRT has been proven beneficial over IHD among hemodynamically unstable postoperative patients. Our objective is to portrait current RRT practices in multidisciplinary management of critically ill patients by intensive care and nephrology professionals. Implication of a nephrologist in the assessment of hemodynamic status, coexisting medical conditions, renal outcome expectations and management of resources could potentially have benefits at the time of RRT selection and troubleshooting.

Copyright © 2020 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

Keywords: Acute kidney injury; Continuous hemofiltration; Critical ill; Filtración continua; Fracaso renal agudo; Hemodialysis; Hemodiálisis; Paciente crítico; Renal replacement therapy; Terapia renal sustitutiva

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