Master Class: AKI and RRT #EuAsia18

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Diagnostic workout of AKI

KDIGO guidelines



Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study.

Basic investigation for all AKI

  • Renal ultrasound
  • Ca
  • Biochemistry
  • Urinalysis – microscopy and electrolytes

The subsequent tests are guided by the clinical picture and history


A prospective evaluation of urine microscopy in septic and non-septic acute kidney injury.

Renal biopsy can be diagnostic and can provide information about background histology. 85% of pts develop peri-renal haematoma.


Future – renal biomarkers





When to start and when to stop RRT

Does this patient with AKI need RRT? 


Strategies for the optimal timing to start renal replacement therapy in critically ill patients with acute kidney injury.

Renal replacement therapy in critically ill patients with acute kidney injury–when to start.

The optimal time of initiation of renal replacement therapy in acute kidney injury: A meta-analysis

Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients With Acute Kidney Injury: The ELAIN Randomized Clinical Trial.

Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit


When to stop –

  1. Has the original precipitant for the AKI resolved?
  2. Is there evidence of some degree of recovery of kidney function?
  3. Has any fluid overload been resolved?

Can this patient be safely weaned from RRT?


The terms ‘early’ and ‘late’ RRT should be replaced with TIMELY RRT

Furosemide stress test/challenge test – 0.5-1mg/kg.


How to select mode of RRT

Depends on resources, where you work

Acute Renal Failure in Critically Ill Patients: A Multinational, Multicenter Study

Intermittent versus continuous renal replacement therapy for acute renal failure in adults: cochrane review


Modality on mortality – no strong data to support continuous or intermittent RRT


Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients

Nice comparison of IHD vs CRRT vs SLED


The dose of RRT

No benefits to higher intensity RRT

Target 25ml/kg/hr


Drug dosing during RRT

Does anyone adjust drug dosing when pt is on SLEDD? If so, how? Even the pharmacist disagree on what to do – Survey of pharmacists’ antibiotic dosing recommendations for sustained low-efficiency dialysis.

SaMpling Antibiotics in Renal Replacement Therapy (SMARRT): an observational pharmacokinetic study in critically ill patients