Methods of renal replacement therapy in intensive care unit

Abstract

This article presents the history of the development of renal replacement therapy (RRT) in patients intensively treated for acute kidney injury (AKI). The basic problem is the significant, high morbidity and, unfortunately, still high mortality due to AKI in patients in intensive care units (ICU). The incidence of AKI in the ICU has been estimated to range from 5% to 50%. Currently, treatment options for RRT include intermittent, prolonged, and continuous therapies. In this article, we focused particular attention on continuous renal replacement therapy (CRRT). The subject of the discussion are the basic dialysis techniques: hemodialysis, hemofiltration, hemodiafiltration, ultrafiltration and peritoneal dialysis. Currently, continuous therapies are preferred in hemodynamically unstable patients requiring vasoactive drugs. However, especially during the COVID-19 pandemic, extended therapy has gained importance, mainly due to the huge increase in the number of patients requiring RRT. In hemodynamically stable patients requiring RRT, intermittent hemodialysis still has its place. An intensive care physician involved in life-saving interventions and treatment of AKI most often uses continuous methods. Cooperation with nephrologists is particularly important in the treatment of a patient with AKI and may contribute to the optimal use of various RRT techniques. The primary goal of this article is to present the process of initiating and conducting RRT in the ICU to a wider group of physicians. Moreover, based on the latest reports, the individual, most frequently used dialysis techniques in the ICU are described.