Delivering optimal renal replacement therapy to critically ill patients with acute kidney injury

Intensive Care Med. 2022 Oct;48(10):1368-1381. doi: 10.1007/s00134-022-06851-6. Epub 2022 Sep 6.


Critical illness is often complicated by acute kidney injury (AKI). In patients with severe AKI, renal replacement therapy (RRT) is deployed to address metabolic dysfunction and volume excess until kidney function recovers. This review is intended to provide a comprehensive update on key aspects of RRT prescription and delivery to critically ill patients. Recently completed trials have enhanced the evidence base regarding several RRT practices, most notably the timing of RRT initiation and anticoagulation for continuous therapies. Better evidence is still needed to clarify several aspects of care including optimal targets for ultrafiltration and effective strategies for RRT weaning and discontinuation.

Keywords: Acute kidney injury; Clinical trials; Intensive care unit; Renal replacement therapy.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury*
  • Critical Illness* / therapy
  • Humans
  • Intensive Care Units
  • Renal Replacement Therapy