Nephrologie auf der Intensivstation

For the treatment of patients with acute kidney injury in the intensive care unit both intermittent and continuous renal replacement therapies (RRT) are used. So far there is no clear evidence that one of these procedures is prognostically superior in terms of mortality; however, results from intervention trials indicated that patient hemodynamic stability and, in particular, recovery of kidney function are more favorable with continuous RRT. Therefore, guidelines now recommend the use of continuous RRT in unstable septic critically ill patients with acute kidney injury. However, due to the high dialysis dose per unit time intermittent RRT is more favorable in cases of severe electrolyte disturbances or intoxication. Nevertheless, intermittent and continuous RRT should not be considered as competitive but rather as two options enabling RRT to be adapted to individual needs with respect to different indications. The dose of RRT seems to have only a limited effect on the prognosis but should be at least 20–25 ml/min/kg body weight in continuous RRT, and should reach at least a weekly Kt/V of 3.9 with intermittent RRT at least 3 times per week. In randomized controlled trials, higher doses of RRT did not have an impact on survival. Finally, regional anticoagulation with citrate results in longer filter circuit life and less bleeding complications compared to anticoagulation with heparin.