Week 9: Renal replacement therapy

Topics to consider

• Who needs Renal Replacement Therapy (RRT) ?

• What types are available? Intermittent dialysis vs continuous RRT

• Indications, advantages, and disadvantages of each?

• How do they work: Diffusion vs convection

• How do you prescribe it?

• How do you troubleshoot it?

• What is plasma exchange, and how is it similar/different?

Resources

• An approach to AKI, and all about contrast-adjacent nephropathy (IBCC)

• Renal replacement therapies in critical care (BJA Education)

• Indications for RRT (LITFL)

• RRT in Critical Care (ATOTW)

• AKI outcomes in critical care (ICS Education)

• Landmark trials in timing RRT (renalfellow.org)

• Renal challenges in COVID-19 patients (ICS Education)

Key trials and guidelines

• What actually happens? AKI-EPI
• Intensity - RENAL, ARF,
• Early vs late - AKIKI, ELAIN, RENAL reanalysis, STARRT-AKI, IDEAL-ICU, AKIKI-2, and a meta-analysis
• Continuous vs intermittent - We, really, really, really, really, are, not, sure, yet, in, any, meaningful, way, (but CRRT might lead to less HD-dependence)
• Heparin vs citrate anticoagulation?
• Try something else? BICAR-ICU, SPARK, SMART

Have we missed something?

Know a great resource or teaching aid that we've missed? Let us know and help make this page even better.