Nephrologists Rather Than Intensivists Should Manage Kidney Replacement Therapy in the ICU: CON

Bagshaw, Sean M.

doi:10.34067/kid.0000092022

Cited by 3 publications

(2 citation statements)

References 16 publications

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“…For example, the respective role of the nephrologist and of the ICU physician influences both choice of modality and cost of KRT. 50–52 In the Beginning and Ending Supportive Therapy for the Kidney post hoc analysis mentioned earlier, intensivists were more likely to prescribe CKRT than nephrologists. In most regions, specialized dialysis nurses provided intermittent HD, which is likely to increase cost, whereas usual ICU nurses provided CKRT.…”

Section: Cost-effectiveness and The Influence Of Icu Organizationmentioning

confidence: 98%

Debate: Intermittent Hemodialysis versus Continuous Kidney Replacement Therapy in the Critically Ill Patient: The Choice Should Be Evidence Based

Chaïbi

Dreyfuss

Gaudry

2023

CJASN

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Kidney replacement therapy (KRT) plays a major role in the treatment of severe AKI. Intermittent hemodialysis (HD) and continuous KRT (CKRT) are the main modalities in critically ill patients with AKI. CKRT is the preferred modality in many countries because of its alleged superiority on both hemodynamic tolerance and on kidney function recovery. In fact, randomized controlled trials (RCTs) comparing the two modalities have not shown any actual benefit of one technique over the other on mortality, hemodynamics, or kidney function recovery. Those RCTs were conducted more than 15 years ago. Major progress was eventually made leading to much lower mortality rates in recent studies than in previous studies. In addition, those RCTs included a noticeable proportion of patients who could have recovered without ever receiving KRT, as demonstrated by several recent studies. In the absence of evidence of clinical superiority of one KRT modality, the choice must be addressed not only regarding clinical outcome but also resources and logistics. Conclusions of health technology assessments and study reports were heterogeneous and conflicting concerning cost-effectiveness of intermittent HD versus CKRT. All these considerations justify a reevaluation of the issue in new RCTs that take into account recent knowledge on KRT initiation and management. Pending results of such study, the choice should be guided mainly by organizational considerations in each unit and without condemning any modality in the absence of proof.

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Section: Cost-effectiveness and The Influence Of Icu Organizationmentioning

confidence: 98%

Debate: Intermittent Hemodialysis versus Continuous Kidney Replacement Therapy in the Critically Ill Patient: The Choice Should Be Evidence Based

Chaïbi

Dreyfuss

Gaudry

2023

CJASN

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“…In the last decade and with the growing accessibility and utilization of CRRT in the ICUs, the controversy of who should prescribe and monitor it in critically ill patients has arised. Intensivists are more available to initiate and adjust the prescription in the ICU and have comprehensive training in multiple organ support 49 .…”

Section: Who Should Prescribe Continuous Renal Replacement Therapy An...mentioning

confidence: 99%

Continuous renal replacement therapy: what have we learned and what are key milestones for the years to come?

Galindo,

Neyra

2023

RIC

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Continuous renal replacement therapy (CRRT) is the main extracorporeal kidney support therapy used in critical ill patients in the intensive care unit (ICU). Since its conceptualization ~50 years ago, there have been major improvements in its technology and utilization. The last decade, and particularly since the COVID-19 pandemic, has been marked by a growing interest and demand of CRRT in worldwide ICUs. This has underpinned the need for improvements in nomenclature and process standardization, optimization of CRRT deliverables, and the development and validation of key performance indicators. Further, how to leverage digital health technologies to build clinical decision support for CRRT and improve personalized bedside decisions is a subject of intense investigation. Herein, we summarize notable advancements in the provision of CRRT and propose areas in need of further development.

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Prevention of Intradialytic Hypotension in Hemodialysis Patients: Current Challenges and Future Prospects

Hamrahian,

Vilayet,

Herberth

et al. 2023

IJNRD

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Intradialytic hypotension, defined as rapid decrease in systolic blood pressure of greater than or equal to 20 mmHg or in mean arterial pressure of greater than or equal to 10 mmHg that results in end-organ ischemia and requires countermeasures such as ultrafiltration reduction or saline infusion to increase blood pressure to improve patient's symptoms, is a known complication of hemodialysis and is associated with several potential adverse outcomes. Its pathogenesis is complex and involves both patient-related factors such as age and comorbidities, as well as factors related to the dialysis prescription itself. Key factors include the need for volume removal during hemodialysis and a suboptimal vascular response which compromises the ability to compensate for acute intravascular volume loss. Inadequate vascular refill, incorrect assessment or unaccounted changes of target weight, acute illnesses and medication interference are further potential contributors. Intradialytic hypotension can lead to compromised tissue perfusion and endorgan damage, both acutely and over time, resulting in repetitive injuries. To address these problems, a careful assessment of subjective symptoms, minimizing interdialytic weight gains, individualizing dialysis prescription and adjusting the dialysis procedure based on patients' risk factors can mitigate negative outcomes.

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Nephrologists Rather Than Intensivists Should Manage Kidney Replacement Therapy in the ICU: CON

Abstract: This is an Early Access article. Please select the PDF button, above, to view it. Be sure to also read the PRO: 10.34067/KID.0000622022 and the COMMENTARY: 10.34067/KID.0002002022

Cited by 3 publications

References 16 publications

Debate: Intermittent Hemodialysis versus Continuous Kidney Replacement Therapy in the Critically Ill Patient: The Choice Should Be Evidence Based

Debate: Intermittent Hemodialysis versus Continuous Kidney Replacement Therapy in the Critically Ill Patient: The Choice Should Be Evidence Based

Continuous renal replacement therapy: what have we learned and what are key milestones for the years to come?

Prevention of Intradialytic Hypotension in Hemodialysis Patients: Current Challenges and Future Prospects

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