Solute and Volume Dosing during Kidney Replacement Therapy in Critically Ill Patients with Acute Kidney Injury

摘要

Among critically ill patients with severe acute kidney injury either continuous kidney replacement therapy (CKRT) or intermittent hemodialysis (IHD) can be performed to provide optimal solute and volume control. The modality of KRT should be chosen based on the needs of the patient, hemodynamic status, clinician expertise, and resource available under a particular setting and consideration of costs. Evidence from high-quality randomized trials suggests that an effluent flow rate of 25 mL/kg/hour per day using CKRT and Kt/V of 1.3 per session of IHD provide optimal solute control. For volume dosing, the net ultrafiltration (UFsubNET/sub) rate should be prescribed based on patient body weight in milliliters per kilogram per hour, with close monitoring of patient hemodynamics and fluid balance. Emerging evidence from observational studies suggests a “J”-shaped association between UFsubNET/sub rate and outcomes with both faster and slower UFsubNET/sub rates being associated with increased mortality compared with moderate UFsubNET/sub rates. Thus, randomized trials are required to determine optimal UFsubNET/sub rates in critically ill patients.