Precision Continuous Renal Replacement Therapy and Solute Control

Academic Article

Abstract

  • © 2016 S. Karger AG, Basel. Copyright: All rights reserved. Continuous renal replacement therapy (CRRT) remains the dominant form of renal support among critically ill patients worldwide. Current clinical practice on CRRT prescription mostly relies on high quality studies suggesting no impact of CRRT dose on critically ill patients' outcomes. Recent clinical practice guidelines have been developed based on these studies recommending a static prescribed CRRT dose of 20-25 ml/kg/h. There is a rationale for renewed attention to CRRT prescription/practice based on the concept of dynamic solute control adapted to the changing clinical needs of critically ill patients. In response, Acute Disease Quality Initiative convened a 17th consensus meeting centered on re-evaluation of CRRT. This work group developed 4 themes focused specifically on CRRT dose prescription, delivery and solute control that were summarized in a series of consensus statements, along with the identification of critical knowledge gaps. CRRT dose prescription and delivery can be based on effluent flow rate. Delivered dose should be routinely monitored to ensure coherence with prescribed dose. CRRT dose should be dynamic, in recognition of between- and within-patient variation in targeted solute control or unintended solute clearance. Quality measures specific for monitoring delivered CRRT dose have been proposed that require further validation, prior to implementation, into the practice of guiding optimal CRRT dosage.
  • Authors

    Published In

  • Blood Purification  Journal
  • Digital Object Identifier (doi)

    Author List

  • Bagshaw SM; Chakravarthi MR; Ricci Z; Tolwani A; Neri M; De Rosa S; Kellum JA; Ronco C
  • Start Page

  • 238
  • End Page

  • 247
  • Volume

  • 42
  • Issue

  • 3