40 Years of Continuous Renal Replacement Therapy. Группа авторов

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      Prof. Patrick M. Honore, MD, PhD, FCCM

      Professor of Medicine, Deputy Chairman of ICU Department

      Director of ICU Research Unit

      Centre Hospitalier Universitaire Brugmann

      Place Van GehuchtenPlein, BE–4-1020 Brussels (Belgium)

      E-mail [email protected]

      Bellomo R, Kellum JA, La Manna G, Ronco C (eds): 40 Years of Continuous Renal Replacement Therapy.

      Contrib Nephrol. Basel, Karger, 2018, vol 194, pp 25–37 (DOI: 10.1159/000485598)

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Indications and Timing of Continuous Renal Replacement Therapy Application

      Sean M. Bagshaw^a · Ron Wald^b

      ^aDepartment of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, and ^bDivision of Nephrology, St. Michael’s Hospital, Toronto, ON, Canada

      ______________________

      Abstract

      Renal replacement therapy (RRT) is increasingly utilized to support critically ill patients with severe acute kidney injury (AKI). The clinical dilemma of when to ideally start RRT in these patients has been a longstanding issue that is in need of higher quality evidence to guide clinical practice. When clinicians are confronted with patients with life-threatening complications of AKI, the decision to start RRT is straightforward. However, in the absence of clear indications, the ideal circumstances and timing that balance the perceived benefits and risks of early versus delayed RRT remain uncertain. Survey data have confirmed substantial practice variation in the timing of RRT initiation. Most observational data and small clinical trials have limitations related to confounding by indication, heterogeneity in case-mix and illness severity, and variation in defining timing thresholds for starting RRT. Recently published trials have further added to the clinical uncertainty. This concise review provides an overview of prevailing and evolving evidence on the optimal time to start RRT in critically ill patients with AKI.

      © 2018 S. Karger AG, Basel

      Introduction

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