ABSTRACTS from 16th International COnference on ... - CRRT Online

B26
Starting and Stopping RRT for AKI: Principles and Practice
Etienne Macedo MD, PhD
8:00-9:30
Thursday, February 16
Educational Objectives:
1. Describe the factors affecting timing of initiation and stopping of RRT in critically ill patients.
2. Discuss the principles and evidence for early intervention with RRT in the ICU
3. Describe various approaches and practical aspects for initiating and stopping RRT
Content Description:
Several randomized studies have tried to delineate the best modality or the optimal dialysis dose to manage acute
kidney injury (AKI), with inconsistent results. One important and still controversial aspect of the management of
critically ill patients is the timing of initiation and cessation of renal replacement therapy (RRT). The lack of consensus
on what parameters should guide the decision to start dialysis has led to a wide variation in dialysis initiation.
A contributing factor is the lack of contemporary studies evaluating the relationship of timing of dialysis initiation
and outcomes. Although listed as one of the top priorities in research on AKI, timing of dialysis initiation
has not been included as a factor in large, randomized controlled trials in this area. Similarly, cessation of RRT has
received little attention and has not been studied extensively. This workshop will utilize cases to illustrate the principles
for determining optimal time for intervention and a strategy for stopping RRT in critically ill patients
Suggested Reading:
1. Liu KD, Himmelfarb J, Paganini E, et al. Timing of initiation of dialysis in critically ill patients with acute kidney injury.
Clin J Am Soc Nephrol 2006; 1: 915-919.
2. Demirkiliç U, Kuralay E, Yenicesu M, et al. Timing of replacement therapy for acute renal failure after cardiac surgery. J
Card Surg 2004; 19: 17-20.
3. Elahi M, Asopa S, Pflueger A, et al. Acute kidney injury following cardiac surgery: impact of early versus late haemofiltration
on morbidity and mortality. Eur J Cardiothorac Surg 2009; 35: 854-863.
4. Andrade L, Cleto S, Seguro A. Door-to-dialysis time and daily hemodialysis in patients with leptospirosis: impact on
mortality. Clin J Am Soc Nephrol 2007; 2: 739-744.
5. Bagshaw SM, Uchino S, Bellomo R, et al. Timing of renal replacement therapy and clinical outcomes in critically ill
patients with severe acute kidney injury. J Crit Care 2009; 24: 129-140.
6. Gibney N, Hoste E, Burdmann EA, et al. Timing of initiation and discontinuation of renal replacement therapy in AKI:
unanswered key questions. Clin J Am Soc Nephrol 2008; 3: 876-880.
7. Seabra V, Balk E, Liangos O, et al. Timing of renal replacement therapy initiation in acute renal failure: a meta-analysis.
Am J Kidney Dis 2008; 52: 272-284.
8. Shiao C, Wu V, Li W, et al. Late initiation of renal replacement therapy is associated with worse outcomes in acute kidney
injury after major abdominal surgery. Crit Care 2009; 13: R171.
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patients with acute kidney injury. Crit Care 2009;13(6):R175.
10. Ostermann M, Chang R, Group RIPU. Correlation between the AKI classification and outcome. Crit Care
2008;12(6):R144.
11. Shiao CC, Wu VC, Li WY, et al. Late initiation of renal replacement therapy is associated with worse outcomes in acute
kidney injury after major abdominal surgery. Crit Care 2009;13(5):R171.
12. Macedo E, Mehta R. Early vs late start of dialysis: it's all about timing. Crit Care 2010;14(1):112.
13. Bouchard J, Macedo E, Mehta RL. Dosing of renal replacement therapy in acute kidney injury: lessons learned <strong>from</strong>
clinical trials. Am J Kidney Dis;55(3):570-579.
14. Macedo E, Mehta RL. When should renal replacement therapy be initiated for acute kidney injury? Semin Dial
2011;24(2):132-137.
15. Karvellas CJ, Farhat MR, Sajjad I, et al. A comparison of early versus late initiation of renal replacement therapy in
critically ill patients with acute kidney injury: a systematic review and meta-analysis. Crit Care 2011;15(1):R72.
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