Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/25296
Title: Ultrafiltration in critically ill patients treated with kidney replacement therapy.
Austin Authors: Murugan, Raghavan;Bellomo, Rinaldo ;Palevsky, Paul M;Kellum, John A
Affiliation: Intensive Care
The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
The Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Issue Date: Apr-2021
metadata.dc.date: 2020-11-11
Publication information: Nature Reviews. Nephrology 2021; 17(4): 262-276
Abstract: Management of fluid overload is one of the most challenging problems in the care of critically ill patients with oliguric acute kidney injury. Various clinical practice guidelines support fluid removal using ultrafiltration during kidney replacement therapy. However, ultrafiltration is associated with considerable risks. Emerging evidence from observational studies suggests that both slow and fast rates of net fluid removal (that is, net ultrafiltration (UFNET)) during continuous kidney replacement therapy are associated with increased mortality compared with moderate UFNET rates. In addition, fast UFNET rates are associated with an increased risk of cardiac arrhythmias. Experimental studies in patients with kidney failure who were treated with intermittent haemodialysis suggest that fast UFNET rates are also associated with ischaemic injury to the heart, brain, kidney and gut. The UFNET rate should be prescribed based on patient body weight in millilitres per kilogramme per hour with close monitoring of patient haemodynamics and fluid balance. Dialysate cooling and sodium modelling may prevent haemodynamic instability and facilitate large volumes of fluid removal in patients with kidney failure who are treated with intermittent haemodialysis, but the effects of this strategy on organ injury are less well studied in critically ill patients treated with continuous kidney replacement therapy. Randomized trials are required to examine whether moderate UFNET rates are associated with a reduced risk of haemodynamic instability, organ injury and improved outcomes in critically ill patients.
URI: https://ahro.austin.org.au/austinjspui/handle/1/25296
DOI: 10.1038/s41581-020-00358-3
ORCID: 0000-0002-6823-6365
0000-0002-7334-5400
0000-0003-1995-2653
PubMed URL: 33177700
Type: Journal Article
Appears in Collections:Journal articles

Show full item record

Page view(s)

26
checked on May 12, 2021

Google ScholarTM

Check


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.