The discussion dives into the challenges of timing renal replacement therapy in critically ill patients. Experts analyze the balance between delaying treatment and the benefits of early intervention for acute kidney injury. Real-world insights reveal how various factors influence patient outcomes. There's a focus on the intricacies involved in managing dialysis for both chronic and acute conditions, shedding light on the critical decision-making process in the ICU.
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RRT Timing in Chronic vs. Acute Kidney Injury
There's a difference between initiating RRT in chronic vs. acute kidney injury settings.
Chronically, one delays RRT, while acutely, earlier intervention was favored.
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Acute kidney injury is a frequent complication of critical illness, and a subgroup of these patients will require renal replacement therapy. In this episode. Dr. Sergio Zanotti discusses optimizing renal replacement therapy in the ICU. He is joined by Dr. Michael J. Connor, Jr., a practicing intensivist and nephrologist. He is a professor and senior physician of critical care medicine and nephrology at the Divisions of Pulmonary, Allergy, Critical Care, & Sleep Medicine and Renal Medicine at Emory University School of Medicine. In addition, he is the director of critical care nephrology at the Emory Critical Care Center at Grady Memorial Hospital.
Additional resources:
Delivering optimal renal replacement therapy to critically ill patients with acute kidney injury. Wald R, et al. Intensive Care Med 2022: https://pubmed.ncbi.nlm.nih.gov/36066597/
Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit. AKIKI Study Group. N Engl J Med 2016: https://pubmed.ncbi.nlm.nih.gov/27181456/
Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients with Acute Kidney Injury. ELAIN Trial. JAMA 2016: https://pubmed.ncbi.nlm.nih.gov/27209269/
Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis. IDEAL-ICU Investigators. N Eng J Med 2018: https://pubmed.ncbi.nlm.nih.gov/30304656/
Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury. STARRT-AKI Investigators. N Engl J Med 2020: https://pubmed.ncbi.nlm.nih.gov/32668114/
Comparison of two delayed strategies for renal therapy initiation for severe acute kidney injury. AKIKI 2 Trial. Lancet 2021: https://pubmed.ncbi.nlm.nih.gov/33812488/
Books and Music mentioned in this episode:
The Invisible Life of Addie LaRue. By V.E. Schwab: The Invisible-Life-Addie-LaRue
Moon Music. By Coldplay: Moon-Music-Coldplay
Critical Matters