Continuous renal replacement therapy: individualization of the prescription

Current Opinion in Critical Care
Ryan W HainesJohn R Prowle

Abstract

Continuous renal replacement therapy (CRRT) is now the mainstay of renal organ support in the critically ill. As our understanding of CRRT delivery and its impact on patient outcomes improves there is a focus on researching the potential benefits of tailored, patient-specific treatments to meet dynamic needs. The most up-to-date studies investigating aspects of CRRT prescription that can be individualized: CRRT dose, timing, fluid management, membrane selection, anticoagulation and vascular access are reviewed. The use of different doses of CRRT lack conventional high-quality evidence and importantly studies reveal variation in assessment of dose delivery. Research reveals conflicting evidence for clinicians in distinguishing which patients will benefit from 'watchful waiting' vs. early initiation of CRRT. Both dynamic CRRT dosing and precision fluid management using CRRT are difficult to investigate and currently only observational data supports individualization of prescriptions. Similarly, individualization of membrane choice is largely experimental. Clinicians have limited evidence to individualize the prescription of CRRT. To develop this, we need to understand the requirements for renal support for individual patients, su...Continue Reading

References

Apr 17, 2009·Critical Care : the Official Journal of the Critical Care Forum·Sergio VesconiUNKNOWN DOse REsponse Multicentre International collaborative Initiative (DO-RE-MI Study Group)
Oct 23, 2009·The New England Journal of Medicine·Rinaldo BellomoSteve Su
Dec 1, 2010·Clinical Journal of the American Society of Nephrology : CJASN·Rolando Claure-Del GranadoRavindra L Mehta
Jun 9, 2011·Critical Care : the Official Journal of the Critical Care Forum·Lucie SeylerFrédérique Jacobs
Sep 8, 2011·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·William D LyndonAshita J Tolwani
May 11, 2013·The International Journal of Artificial Organs·Adriana Boschetti-de-FierroBernd Krause
Jul 16, 2013·Mediators of Inflammation·Wibke SchulteRichard Bucala
Dec 3, 2013·Critical Care : the Official Journal of the Critical Care Forum·Matthieu LegrandDidier Payen
Mar 1, 2012·Kidney International Supplements
Jan 17, 2015·Nephron. Clinical Practice·Carole DangoisseMarlies Ostermann
Apr 18, 2015·Critical Care : the Official Journal of the Critical Care Forum·Darren M RobertsUNKNOWN RENAL Replacement Therapy Study Investigators
Apr 1, 2012·Clinical Kidney Journal·Diana VassalloMarlies Ostermann
Jul 30, 2015·Kidney International·Nitin V KolheMaarten W Taal
Apr 17, 2016·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Jung Tak ParkUNKNOWN HICORES Investigators
May 18, 2016·The New England Journal of Medicine·Stéphane GaudryUNKNOWN AKIKI Study Group
Aug 27, 2016·Blood Purification·Sean M BagshawUNKNOWN ADQI Consensus Group
Aug 27, 2016·Blood Purification·Raghavan MuruganUNKNOWN Acute Disease Quality Initiative (ADQI) Consensus Group
Jan 26, 2017·Clinical Journal of the American Society of Nephrology : CJASN·Mallika L MenduSushrut S Waikar
May 5, 2017·The American Journal of Clinical Nutrition·Andrea M NewJohn M Miles
Aug 6, 2017·Advances in Chronic Kidney Disease·Alexander R Shaw, Bruce A Mueller
Nov 22, 2017·Blood Purification·Zachary O'BrienUNKNOWN RENAL Study Investigators and the Australian and New Zealand Intensive Care Clinical Trials Group
Dec 3, 2017·Journal of the American Society of Nephrology : JASN·Melanie MeerschAlexander Zarbock
Jan 20, 2018·American Journal of Respiratory and Critical Care Medicine·Stéphane GaudryDidier Dreyfuss
Jan 23, 2018·Nature Reviews. Nephrology·John A Kellum, John R Prowle
Feb 23, 2018·Critical Care : the Official Journal of the Critical Care Forum·Adrianna DouvrisEdward G Clark
Apr 18, 2018·Acta Anaesthesiologica Scandinavica·R E BerthelsenM H Bestle
May 8, 2018·Intensive Care Medicine Experimental·Benjamin MalardJohn A Kellum
Jul 8, 2018·Critical Care : the Official Journal of the Critical Care Forum·Bo YouYi Zhi Peng

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Citations

Mar 24, 2021·Seminars in Dialysis·John Prowle, Ravindra Mehta
Oct 2, 2020·Current Opinion in Critical Care·Zaccaria RicciNuttha Lumlertgul

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