2025 Multiprofessional Critical Care Review: Adult Online-Acute Kidney Injury and Renal Replacement Therapy

Video Transcription

Video Summary

This lecture covers acute kidney injury (AKI) diagnosis, management, and renal replacement therapy (RRT). Using the KDIGO criteria, AKI stages are defined by urine output duration and creatinine increase. Initial management focuses on fluid resuscitation with balanced crystalloids guided by clinical assessment and imaging. The SMART and SALT-ED trials suggest balanced fluids may reduce major adverse kidney events compared to normal saline, though evidence isn’t definitive. AKI causes include sepsis, nephrotoxins, and cardiogenic or hepatorenal syndromes. Contrast-induced AKI remains controversial, with precautions recommended for high-risk patients. Antibiotics like vancomycin can contribute to AKI, requiring careful monitoring. Indications for RRT include refractory acidosis, hyperkalemia, volume overload, and worsening renal function. Timing studies (AKIKI, IDEAL ICU) show no mortality difference between early and delayed RRT initiation, guiding individualized decisions based on illness severity and trajectory. Continuous RRT is preferred in hemodynamically unstable or neurologically vulnerable patients, while intermittent hemodialysis suits toxin clearance and stable patients.

Keywords

acute kidney injury

KDIGO criteria

renal replacement therapy

fluid resuscitation

balanced crystalloids

contrast-induced AKI

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