Topic Discussion: Renal Replacement Therapy in the ICU

A nice review in recent Nephrology Nature Review discusses the evidence of issues regarding Continuous Renal Replacement Therapy.

Few questions had arisen, few answered and few unanswered according to this review

1. What is the right CRRT dose? Based on the ATN and RENAL trial, both found that no specific mortality benefit was reached with high dosing of RRT. One should favor conventional dosing target of 20-25ml/kg/hr.

2. What is better CRRT or IHD in ICU patients? NOT evidence based but concensus is in favor of using CRRT in unstable patients who are critically ill

3. Timing of CRRT: When to start? early vs late vs never? Not compared or studied well

4. Do outcomes change: Few studies showed no mortality benefit. But article suggests the focus should be on Renal outcomes and not mortality? So not resolved yet

5. Which modality to use: CVVH vs CVVHD vs CVVHDF vs SCUF in the right setting. No real studies but all might be equivalent in the long run!

Check it out
http://www.ncbi.nlm.nih.gov/pubmed/20644583