ASN Podcast nephSAP Guest Editor Interview: Delivering kidney replacement therapy in the ICU: Closing evidence gaps
Sep 9, 2024
Renowned nephrologist Ron Wald from St. Michael's Hospital dives into crucial topics surrounding kidney replacement therapy in the ICU. He discusses the latest research on dialysis initiation and patient outcomes, emphasizing the need for individualized care in acute kidney injury. Wald highlights the importance of rigorous clinical trials and alternative outcome measures beyond urea clearance. He also tackles the complexities of fluid management and ultrafiltration rates, advocating for a nuanced approach to enhance patient safety and treatment efficacy.
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Lower Dialysis Dose Likely Adequate
- Lower intensity dialysis doses may not be inferior to current standard doses in ICU AKI patients.
- Non-inferior lower doses could reduce complications like hypophosphatemia and preserve antibiotic levels.
Beyond Urea Clearance in AKI
- Urea clearance is an imperfect marker for dialysis adequacy in AKI.
- Focus should shift toward clinical goals like fluid balance and acid-base control to help patients recover globally.
Oliguria Guides Dialysis Timing
- Oliguria may identify AKI patients who benefit from earlier dialysis initiation.
- Timing should consider clinical trajectory rather than strict arbitrary cutoffs to avoid harm from prolonged AKI.