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ultrafiltration haemodialysis

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4.8 - Renal Replacement Therapy in Critical Care
from Section 4 - Therapeutic Interventions and Organ Support
- By Nuttha Lumlertgul, Marlies Ostermann, Gursharan Paul Singh Bawa
Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
Book:

Intensive Care Medicine

Published online:

27 July 2023

Print publication:

01 December 2021, pp 500-509
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Summary

Key Learning Points
1. Conventional indications for renal replacement therapy (RRT) are refractory hyperkalaemia, refractory metabolic acidosis, pulmonary oedema, uraemia and sustained oliguria or anuria with fluid overload.
2. Two major principles of RRT are diffusion and convection.
3. Intermittent haemodialysis (IHD), prolonged intermittent renal replacement therapy (PIRRT) and continuous renal replacement therapy (CRRT) are commonly used in intensive care units. These modalities differ in regard to the duration of therapy and blood flow rate, hence the rapidity of solute and fluid removal. They are used to supplement one another according to each patient’s status and clinical settings.
4. When prescribing CRRT, the modality, vascular access, blood flow rate, dose, anticoagulation, target fluid balance and fluid composition should be considered.
5. RRT-related complications, such as vascular access complications, hypotension and electrolyte imbalances, should be frequently monitored, prevented and appropriately managed.