2025 Multiprofessional Critical Care Review: Adult Online-8: Renal Replacement Therapy Strategies in the ICU

Video Transcription

Video Summary

In this video, Dr. Anita Vijay discusses renal replacement therapy (RRT) in the ICU. She starts by introducing herself and her role as a professor of medicine and medical director for acute dialysis services. The objective of her talk is to describe the various forms of RRT and how they are used, as well as the advantages and disadvantages of each modality. She also discusses the timing of initiation of RRT, considering factors such as severity of illness, patients' ability to handle metabolic requirements, and patient preferences. She then reviews several studies that have looked at the timing of initiation of RRT and highlights the lack of consensus on the optimal timing. Dr. Vijay then discusses the different modalities of RRT, including intermittent hemodialysis, continuous renal replacement therapy (CRRT), and prolonged intermittent renal replacement therapy (PERT). She compares the outcomes of studies that have compared intermittent hemodialysis to CRRT and concludes that there is no significant difference in mortality. She also discusses the role of convection and diffusion in CRRT and highlights the need for further research in this area. Dr. Vijay then discusses the dosing of RRT, recommending an effluent flow rate of 20-25 mL/kg/hr for CRRT and a urea reduction ratio of 70% for intermittent hemodialysis. She also mentions the use of PERT as a hybrid therapy, and briefly discusses anticoagulation and drug dosing considerations for RRT. She concludes by summarizing the key points covered in the video.

Keywords

renal replacement therapy

ICU

intermittent hemodialysis

continuous renal replacement therapy

timing of initiation

effluent flow rate

anticoagulation

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