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Continuous renal replacement therapy

individualization of the prescription

Haines, Ryan W.a,b; Kirwan, Christopher J.a,b,c; Prowle, John R.a,b,c

Current Opinion in Critical Care: December 2018 - Volume 24 - Issue 6 - p 443–449
doi: 10.1097/MCC.0000000000000546
RENAL SYSTEM: Edited by Thomas Rimmelé
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Purpose of review Continuous renal replacement therapy (CRRT) is now the mainstay of renal organ support in the critically ill. As our understanding of CRRT delivery and its impact on patient outcomes improves there is a focus on researching the potential benefits of tailored, patient-specific treatments to meet dynamic needs.

Recent findings The most up-to-date studies investigating aspects of CRRT prescription that can be individualized: CRRT dose, timing, fluid management, membrane selection, anticoagulation and vascular access are reviewed. The use of different doses of CRRT lack conventional high-quality evidence and importantly studies reveal variation in assessment of dose delivery. Research reveals conflicting evidence for clinicians in distinguishing which patients will benefit from ‘watchful waiting’ vs. early initiation of CRRT. Both dynamic CRRT dosing and precision fluid management using CRRT are difficult to investigate and currently only observational data supports individualization of prescriptions. Similarly, individualization of membrane choice is largely experimental.

Summary Clinicians have limited evidence to individualize the prescription of CRRT. To develop this, we need to understand the requirements for renal support for individual patients, such as electrolyte imbalance, fluid overload or clearance of systemic inflammatory mediators to allow us to target these abnormalities in appropriately designed randomized trials.

aAdult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust

bWilliam Harvey Research Institute, Queen Mary University of London

cDepartment of Renal Medicine and Transplantation, The Royal London Hospital, Barts Health NHS Trust, London, UK

Correspondence to John R. Prowle, Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK. E-mail: j.prowle@qmul.ac.uk

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