Continuous renal replacement therapy versus intermittent hemodialysis in intensive care patients: impact on mortality and renal recovery

Truche, Anne-Sophie; Darmon, Michaël; Bailly, Sébastien; Clec’h, Christophe; Dupuis, Claire; Misset, Benoît; Azoulay, Élie; Schwebel, Carole; Bouadma, Lila; Kallel, Hatem; Adrie, Christophe; Dumenil, Anne-Sylvie; Argaud, Laurent; Marcotte, Guillaume; Jamali, Samir; Zaoui, Philippe; Laurent, Virginie; Goldgran-Tolédano, Dany; Sonneville, Romain; Souweine, Bertrand; Timsit, Jean‐François

doi:10.1007/s00134-016-4404-6

Cited by 99 publications

(77 citation statements)

References 40 publications

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“…The ongoing uncertainty with regard to the optimal modality relates to concerns such as subsequent risk of CKD [70], along with identification of specific subgroups (e.g. patients with fluid overload) in which a specific modality may be favoured [71]. In addition, the heterogeneity of patients, organizational and practical issues, along with the impact of variable prescription and execution [72] may have acted as unadjusted confounders and blurred evidence and conclusions.…”

Section: Remaining Uncertainties (Table 1)mentioning

confidence: 99%

The intensive care medicine agenda on acute kidney injury

et al. 2017

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Acute kidney injury (AKI) is a common complication in the critically ill. Current standard of care mainly relies on identification of patients at risk, haemodynamic optimization, avoidance of nephrotoxicity and the use of renal replacement therapy (RRT) in established AKI. The detection of early biomarkers of renal tissue damage is a recent development that allows amending the late and insensitive diagnosis with current AKI criteria. Increasing evidence suggests that the consequences of an episode of AKI extend long beyond the acute hospitalization. Citrate has been established as the anticoagulant of choice for continuous RRT. Conflicting results have been published on the optimal timing of RRT and on the renoprotective effect of remote ischaemic preconditioning. Recent research has contradicted that acute tubular necrosis is the common pathology in AKI, that septic AKI is due to global kidney hypoperfusion, that aggressive fluid therapy benefits the kidney, that vasopressor therapy harms the kidney and that high doses of RRT improve outcome. Remaining uncertainties include the impact of aetiology and clinical context on pathophysiology, therapy and prognosis, the clinical benefit of biomarker-driven interventions, the optimal mode of RRT to improve short- and long-term patient and kidney outcomes, the contribution of AKI to failure of other organs and the optimal approach for assessing and promoting renal recovery. Based on the established gaps in current knowledge the trials that must have priority in the coming 10 years are proposed together with the definition of appropriate clinical endpoints.

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Section: Remaining Uncertainties (Table 1)mentioning

confidence: 99%

The intensive care medicine agenda on acute kidney injury

et al. 2017

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“…The benefit from such early nephrologist involvement has been suggested by low level evidence studies [10]. In some countries, their help might also be required to select an adequate renal replacement modality and run intermittent haemodialysis, the latter limiting need for anticoagulation, limiting costs and performing better in subgroups of patients without shock [11,12]. Finally, they may participate in ICU multidisciplinary daily rounds, increasing quality and safety as suggested by guidelines from the European Society of Intensive Care Medicine [13].…”

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confidence: 99%

A nephrologist should be consulted in all cases of acute kidney injury in the ICU: yes

Darmon

2017

Intensive Care Med

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“…They studied data from 1,360 critically ill patients from 19 ICUs in France who had AKI treated by either CRRT or IHD between 2004 and 2010 whose clinical data had been entered in an observational prospective multicenter cohort (19).…”

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Continous renal replacement therapy and intermittent hemodialysis in acute kidney injury: equivalent or complementary?

Gibney

2016

J. Thorac. Dis.

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Continuous renal replacement therapy versus intermittent hemodialysis in intensive care patients: impact on mortality and renal recovery

Abstract: Continuous RRT did not appear to improve 30-day and 6-month patient outcomes. It seems beneficial for patients with fluid overload, but might be deleterious in the absence of hemodynamic failure.

Cited by 99 publications

References 40 publications

The intensive care medicine agenda on acute kidney injury

The intensive care medicine agenda on acute kidney injury

A nephrologist should be consulted in all cases of acute kidney injury in the ICU: yes

Continous renal replacement therapy and intermittent hemodialysis in acute kidney injury: equivalent or complementary?

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