ICU SAQs · Renal / RRT
RRT modality choice in a haemodynamically unstable patient
A CICM SAQ on the RRT modality selection — the CRRT (CVVHDF) for the haemodynamically unstable, the citrate anticoagulation, the 20-25 mL/kg/h dose, and the timing (the absolute indications).
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Prompt
A 70-year-old with a septic shock and an oliguric AKI requires the renal replacement therapy. The patient is on a high dose of the noradrenaline. Discuss the modality choice, the anticoagulation, and the dosing.
Question
A 70-year-old with a septic shock and an oliguric AKI requires the renal replacement therapy. The patient is on a high dose of the noradrenaline. Discuss the modality choice, the anticoagulation, and the dosing.[2]
References5ShowHide
- [1]Zarbock A, Küllmar M, Kindgen-Milles D, et al. Effect of Regional Citrate Anticoagulation vs Systemic Heparin Anticoagulation During Continuous Kidney Replacement Therapy on Dialysis Filter Life Span and Mortality Among Critically Ill Patients With Acute Kidney Injury: A Randomized Clinical Trial JAMA, 2020.PMID 33095849
- [2]Palevsky PM, Zhang JH, O'Connor TZ, et al. Intensity of renal support in critically ill patients with acute kidney injury N Engl J Med, 2008.PMID 18492867
- [3]Bellomo R, Cass A, Cole L, et al. Intensity of continuous renal-replacement therapy in critically ill patients N Engl J Med, 2009.PMID 19846848
- [4]Bagshaw SM, Chakravarthi MR, Ricci Z, et al. Precision Continuous Renal Replacement Therapy and Solute Control Blood Purif, 2016.PMID 27562079
- [5]Link A, Klingele M, Speer T, et al. Total-to-ionized calcium ratio predicts mortality in continuous renal replacement therapy with citrate anticoagulation in critically ill patients Crit Care, 2012.PMID 22643456