Optimizing the timing of renal replacement therapy in burn patients with acute kidney injury |
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| Affiliation: | 1. Guy’s and St. Thomas’ NHS Foundation Trust, London, UK. Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece;2. Burn ICU Department, George Papanikolaou General Hospital of Thessaloniki, Leof. Papanikolaou, Pilea Chortiatis, Greece;3. Shriners Hospitals for Children-Northern California, Firefighters Burn Institute Regional Burn Center, Department of Surgery, University of California, Davis, Sacramento, CA, USA;1. University of Health Science, Kartal Dr Lütfi K?rdar City Hospital, Burn and Wound Center, Istanbul, Turkey;2. Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey;1. Leicester Royal Infirmary Hospital, United Kingdom;2. University of Cambridge, United Kingdom;1. Service of adult intensive care, Lausanne University Hospital (CHUV), Lausanne, Switzerland;2. Institute of Higher Education and Research in Healthcare (IFS), Faculty of Biology & Medicine, Lausanne University, and Lausanne University Hospital (CHUV), Lausanne, Switzerland;1. Health Sciences of Facult, Department of Child Health and Diseases Nursing, Harran University, ?anl?urfa 63000, Turkey;2. Faculty of Nursing, Department of Child Health and Diseases Nursing, Inönü University, Malatya 44280, Turkey;3. School of Health, Department of Child Health Nursing, Ad?yaman University, Ad?yaman 02000, Turkey;4. Department of Child Health ve Disease of Nursing, Adana Yuregir State Hospital-Child Health and Diseases Service, Adana, Turkey;1. Department of Plastic and Reconstructive Surgery, All India Institute of Medical Sciences, New Delhi, India;2. Department of Plastic Surgery, Linköping University Hospital, Sweden;3. Papanikolaou Hospital, Thessaloniki, Greece;4. Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Canada;5. Department of Anaesthesia and Intensive Care, City of Health and Science, CTO Hospital, Turin, Italy |
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| Abstract: | Acute kidney injury is a common complication in burn ICU patients and is associated with a high mortality rate. The optimal timing for starting renal replacement therapy (RRT) remains unknown; there is no established universal definition for early and late RRT initiation. The aims of the present narrative review are to briefly analyze the available recently published data on the timing of initiation of RRT in critically ill patients and to discuss the optimal timing of RRT in critically ill burn patients with acute kidney injury. When considering renal replacement therapy for acute kidney injury patients, physicians face the dilemma of balancing the hazards of starting too early, exposing patient to an unnecessary therapy with possible complications and costs related to treatment, and preventing a significant proportion of patients from spontaneous recovery of their renal function against the potential life-threatening harm of initiating RRT) too late. Evidence suggests that with appropriate care up to 80% of burn patients experience recovery of kidney function and the need for RRT seems to be very rare after hospital discharge. In the absence of life-threatening complications, the optimal time and thresholds for starting RRT in burn patients are uncertain. High heterogeneity exists between studies on RRT timing in burn patients. |
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| Keywords: | Burn Acute kidney injury Renal replacement therapy Timing Controversies |
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