I mean who choose the best Ideal mode of RRT ( SLED - CRRT - IHD ) for the patients ? Is there any RRT team in your hospital or nephrologists reply the consultation ? or ICU men ?
SLED : sustained low efficacy daily dialysis
CRRT : continuous renal replacement therapy
IHD : intermittent hemodialysis
The first 2, its the intensivists in consultation with the nephrology team, but for the IHD, the nephrologists independently decide.
Dear Edward
i mean is there any need to have a RRT team to decide the type of RRT can be best for the patients who are admitted in hospital wards .
Surgical intensivist in consultation with Nephrology team decide the best therapy for the patients at our institution. We use either CRRT or IHD depending on hemodynamics of the patient.
Ifthe patient is in ICU with AKI, intensivists decide and it is always CVVH (no diafiltration in our ICU, we don't use it!!!!).
We rarely have a patient on intermittent HD in our ICU. If we do, nephrologists (whos patients they are) decide and conductit.
Renal replacement therapy in the intensive care unit
Neesh Pannu1 and RT Noel Gibney2
Abstract
Acute renal failure is a common complication in the intensive care unit (ICU). Over the last 25 years, there have been significant technological advances in the delivery of renal replacement therapy, particularly as it pertains to the critically ill patient population. Despite these advances, acute renal failure in critically ill patients continues to carry a poor prognosis. In this article, we review the current literature about timing and initiation of renal replacement therapy in the ICU as well as practical considerations regarding the prescription and delivery of dialysis.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1661614/
Renal Replacement Therapy and Transplantation
Renal replacement therapy has a vital role in the treatment of severe acute kidney injury(AKI) and end-stage renal disease.
Most patients with chronic kidney disease (CKD) stage 4-5 (estimated glomerular filtration rate (eGFR)
Renal replacement therapy (dialysis) in acute kidney injury in adults: Indications, timing, and dialysis dose
INTRODUCTION
The management of patients with acute kidney injury (AKI) is principally supportive, with renal replacement therapy (RRT) indicated in patients with severe kidney injury. Multiple modalities of RRT are available. These include intermittent hemodialysis (IHD); continuous renal replacement therapies (CRRTs); and hybrid therapies, also known as prolonged intermittent renal replacement therapies (PIRRT), such as sustained low-efficiency dialysis (SLED) and extended duration dialysis (EDD). Despite these varied techniques, mortality in patients with AKI remains high, exceeding 40 to 50 percent in severely ill patients. (See "Renal and patient outcomes after acute tubular necrosis".)
The initiation of RRT in patients with AKI prevents uremia and immediate death from the adverse complications of renal failure. It is possible that variations in the timing of initiation, modalities, and/or dosing may affect clinical outcomes, particularly survival. However, there is a paucity of studies in which these issues have been addressed directly.
The optimal timing, type of modality, and dosing strategy for patients with AKI who require RRT will be reviewed here. The different modalities are discussed separately.
http://www.uptodate.com/contents/renal-replacement-therapy-dialysis-in-acute-kidney-injury-in-adults-indications-timing-and-dialysis-dose
- Acute renal failure in our icu is treated by intensivists who decide which is the best mode of RRT for each patient (CVVHD, CVVHF, CVVHDF). We have no intermittent dialysis. If we need it, we call nephrology team.
RRT mode in our ICU is usually chosen by nephrologists. For critical care patients they always use CRRT.
RRT mode is always chosen by the intensivists, not nephrology. Ours is a closed ICU, as are most (>85% ICUs in the UK). In our ICU we use CVVH, no diafiltratior or IRT
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