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Renal replacement therapy in the critically ill: getting it right

Ricci, Zaccariaa; Ronco, Claudiob

Current Opinion in Critical Care: December 2012 - Volume 18 - Issue 6 - p 607–612
doi: 10.1097/MCC.0b013e328359fdb5
RENAL SYSTEM: Edited by Lakhmir S. Chawla

Purpose of review Survival of critically ill patients with severe acute kidney injury is still low. The aim of this review is to describe recent scientific evidence on renal replacement therapy (RRT) and its potential implications for future research and clinical practice.

Recent findings Timing, dose and special indications of RRT will be described: recent literature provided new answers and new controversies about these three topics.

Summary Specific research on RRT timing will be mandatory in the next few years: a standard definition of timing will certainly help to shed new light on how to improve RRT patients’ outcome. Dialytic dose of continuous RRT has been recently and definitely standardized to 20–25 ml/kg per hour (dialysis or hemofiltration), however, application to clinical practice still needs to be improved and new evidence on net ultrafiltration prescription showed that fluid balance may be as important as blood purification in critically ill patients with renal dysfunction. Special settings such as septic RRT, pediatric RRT, and RRT during extracorporeal membrane oxygenation recently achieved important results and new applications in clinical practice with important consequences for technical improvement and future care of these patients.

aPediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome

bDepartment of Nephrology, Dialysis and Transplantation, International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy

Correspondence to Claudio Ronco, MD, Department of Nephrology Dialysis & Transplantation, International Renal Research Institute, San Bortolo Hospital, Viale Rodolfi 37, 36100 Vicenza, Italy. Tel: +39 0444 753869; fax: +39 0444 753949; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.