Increased intensity of renal replacement therapy to reduce mortality in patients with acute kidney injury

Abstract

Renal replacement therapy (RRT) is currently the only reasonable approach in the clinical management of patients with severe acute kidney injury (AKI). However, there is scarce literature evidence to clearly identify the most efficacious RRT approach. High-intensity RRT may be suggested for fluid and solute control in critically ill patients. Indeed, this strategy has been shown to provide a survival benefit in patients with AKI. Yet, more recent large randomized trials did not confirm these findings. Ultimately, the adequacy of treatment should take into consideration not only the prescribed “dose” but also the actually delivered dose through continuous monitoring of treatment. Anticoagulation has a key role in reducing downtime and membrane fouling and, accordingly, discrepancies between the prescribed and the actually delivered dose.