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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. 9. Ostermann M, Chang RW. Correlation between parameters at initiation of renal replacement therapy and outcome in 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. 107
C27 Acid Base and Electrolyte Problems in the Critically Ill 2 Andrew Lewington MD 8:00-9:30 Thursday, February 16 Educational Objectives: 1. Real clinical cases will be used to demonstrate a range of acid-base and electrolyte problems in the critically ill patient 2. There will be an opportunity to work through the cases in a systematic way encouraging the audience to develop their own answers 3. Provide the attendees with the knowledge on how to diagnose acid-base electrolyte problems in patients and their institutions Content Description: There will be a series of case presentations that will demonstrate a whole range of acid-base and electrolyte problems in the critically ill patient. The lecturers will present the cases in a systematic way to enable a good level of understanding. Following the lecture the attendees will have frameworks to enable them to approach acid-base and electrolyte problems in their institutions. Suggested Reading: 1. Up-to-date 108
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CRRT 2012 SEVENTEENTH INTERNATIONAL
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FACULTY DISCLOSURES CRRT 2012 Facul
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CRRT 2012 ORGANIZING COMMITTEE USA
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CRRT 2012 FACULTY Patrick Honoré,
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ACKNOWLEDGEMENTS CRRT 2012 ACKNOWLE
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PLENARY SESSIONS CRRT 2012 PROGRAM/
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WORKSHOPS CRRT 2012 PROGRAM/INDEX T
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WORKSHOPS CRRT 2012 PROGRAM/INDEX W
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POSTER ABSTRACTS C
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POSTER ABSTRACTS C
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NURSING FORUM LUNCHEON Communicatio
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Nutritional Support in ICU Patients
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Educational Objectives: The Endothe
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SPECIAL LECTURE Engineering Critica
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Nishimura R, Ornato JP, Page RL, Ri
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Do Vasoactive Drugs and Fluids Impr
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Blood Transfusions are Important fo
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Thinking Outside of the Box: A Nove
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Nursing Forum 2 Luncheon Benchmarki
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4. Mori K, Lee HT, Rapoport D, Drex
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Differential Diagnosis of AKI: Can
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Myocardial Stunning and Brain Edema
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4. Udy A, Roberts JA, Lipman J. Wha
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CRRT and ECMO: Techniques and Outco
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Management of Severe Heart Failure:
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Avoiding Anticoagulation for CRRT:
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Page 60 and 61: The Changing Face of AKI: Snapshots
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