RT Book, Section A1 Udani, Suneel M. A1 Koyner, Jay L. A1 Murray, Patrick T. A2 Hall, Jesse B. A2 Schmidt, Gregory A. A2 Kress, John P. SR Print(0) ID 1107723448 T1 Renal Replacement Therapy in the Intensive Care Unit T2 Principles of Critical Care, 4e YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 9780071738811 LK accesssurgery.mhmedical.com/content.aspx?aid=1107723448 RD 2024/03/28 AB Indications for the initiation of renal replacement therapy (RRT) remain reactive, often waiting until potentially life-threatening complications/thresholds have been met.The goal of renal replacement therapy should be to provide “renal support” to facilitate the other aspects of care of the critically ill patient (fluid balance, nutritional support, etc).Retrospective and observational studies suggest that the early initiation of RRT may improve patient outcomes; however, definitive randomized, controlled trials have yet to be performed.In the setting of acute kidney injury (AKI), no specific RRT modality (intermittent, continuous, or peritoneal) provides a mortality benefit over another. However, certain clinical scenarios (eg, hepatic failure, increased intracranial pressure) may mandate a specific modality.In the setting AKI, randomized controlled trials have demonstrated that a minimum dose of 25 mL/kg/h of continuous renal replacement therapy (CRRT) be delivered in order to improve patient survival. Data on dosing of intermittent dialysis suggest prescription of a minimum of three treatments per week.No singular method of systemic or regional anticoagulation, in the setting of AKI requiring renal replacement therapy, has demonstrated superiority. Several options including heparin, citrate, and no anticoagulation remain extremely common and each has their own risks and benefits.In the setting of AKI requiring RRT, nutritional support consistent with the current ESPEN guidelines and monitoring of parameters of nutritional status in critically ill patients are appropriate.Depending on the modality of RRT (intermittent, continuous, or peritoneal), dosing strategies for medications (including antimicrobials) differ significantly.Adherence to dosing guidelines is critical to ensure that the targeted therapeutic dose is delivered in the setting of AKI and RRT, as inappropriate dosing has a significant impact on patient outcomes and increases the risk of mortality.