Contributions to nephrology
-
Renal replacement therapy (RRT) is commonly and increasingly utilized in critically ill patients with severe acute kidney injury (AKI). The issue of when to start RRT in a critically ill patient with AKI has long troubled clinicians. ⋯ Several large randomized trials are planned or ongoing, and the results of these trials will greatly inform best clinical practice and will help reduce unnecessary variation in the practice of RRT prescription. For now, the decision on the appropriate time to start RRT is naturally complex, integrating numerous variables, and should largely be individualized.
-
The goal of fluid therapy in critical care medicine is to restore hemodynamic stability and vital organ perfusion while avoiding interstitial edema. Acute kidney injury (AKI) is a common complication in critically ill patients. Decisions regarding fluid management in critically ill patients with AKI are difficult, as these patients often have accompanying oliguria as well as body fluid overload. ⋯ Balanced solutions may reduce the risk of hyperchloremic acidosis and kidney injury. In summary, volume management is an integral part of the care of critically ill patients with AKI. An optimal strategy might involve a timely period of guided fluid resuscitation with appropriate solutions, followed by an appropriate fluid balance.