Dosing renal replacement therapy

Todd Fraser on 20-06-2010

The College of Intensive Care Medicine recently staged its annual Scientific Meeting. The theme for this year was Nephrology and among the many fascinating subjects covered, one of the most contentious was the dosing of renal replacement therapy. As far as I can tell, the evidence suggests no benefit from higher doses of renal replacement therapy compared with what we currently consider "standard". The RENAL and ATN studies, both released in recent years, have their differences but are essentially in agreement on this issue. However, the scientific basis for "standard" remains thready. Triggers to start dialysis are far less clear. While many of the experts at the conference agree that earlier is better, there is no agreement on what triggers, if any, should be used to initiate it. Similarly, the indications for ceasing CRRT remain obscure. What do you do?

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Todd Fraser wrote 08-14-2010 04:18:03 pm
There was a fantastic podcast on the SCCM site by John Kellum on this topic.

Todd Fraser wrote 07-18-2010 10:30:35 am
I asked Rinaldo Bellomo what he thought of all this :

"Hi Todd,

All reasonable.
You can say that my opinion is this:
1. Start early
2. Finish late
3. Do not use IHD
4. Use the RIFLE criteria to help you decide when to start
5. Use the urine output to help you decide when to stop

Rinaldo"

On this last point, he gave me the following reference - (Crit Care Med 2009; 37:2576 2582) - which you can also find in the library.