Nephrology
Renal failure & renal replacement therapy
Acute kidney injury (AKI) is a critical condition in intensive care, characterized by rapid deterioration of renal function. Effective management involves early detection, risk stratification, and tailored interventions, including fluid management and avoidance of nephrotoxic agents. Renal replacement therapy (RRT) is essential for managing AKI, with modalities like intermittent hemodialysis and continuous renal replacement therapy (CRRT) tailored to patient needs. Understanding RRT nomenclature and membrane properties enhances treatment efficacy and safety.
Antimicrobial drug dosing in patients undergoing RRT requires careful consideration due to altered pharmacokinetics. Therapeutic drug monitoring (TDM) and individualized dosing strategies are crucial for optimizing therapeutic outcomes and minimizing toxicity. Comprehensive resources like the Renal Drug Handbook provide essential guidance on drug therapy in renal patients, ensuring effective and safe treatment.
Acute kidney injury
Acute kidney injury (AKI)
Summary of Recommendation Statements
KDIGO, Kidney International Supplements (2012)
What’s inside
This article provides a comprehensive summary of recommendation statements from the Kidney Disease: Improving Global Outcomes (KDIGO) initiative, focusing on the definition, prevention, and treatment of acute kidney injury (AKI).
Why it’s relevant
AKI is a common and serious complication in critically ill patients, associated with increased morbidity and mortality. These guidelines offer evidence-based recommendations to improve the management and outcomes of AKI.
Key focus
- Definition and staging of AKI based on serum creatinine levels and urine output
- Risk stratification and management strategies to prevent AKI in high-risk patients
- Recommendations for fluid management, use of vasopressors, and avoidance of nephrotoxic agents
- Guidelines for the use of renal replacement therapy (RRT), including initiation, modality, and anticoagulation strategies
- Specific considerations for contrast-induced AKI and dialysis interventions
Takeaway
The KDIGO recommendations provide a structured approach to managing AKI, emphasizing early detection, risk stratification, and tailored interventions to improve patient outcomes in intensive care settings.
Acute kidney injury
Acute kidney injury 2016: diagnosis and diagnostic workup
Marlies Ostermann et al., Critical Care (2016)
What’s inside
This article reviews the current understanding of the diagnosis and diagnostic workup of acute kidney injury (AKI), focusing on the latest advancements and recommendations as of 2016.
Why it’s relevant
AKI is a critical condition in intensive care medicine, and timely and accurate diagnosis is essential for effective management and improved patient outcomes.
Key focus
- Definition and classification of AKI, including the use of RIFLE, AKIN, and KDIGO criteria
- Importance of early recognition and diagnosis of AKI in critically ill patients
- Role of biomarkers in the diagnosis and prognosis of AKI
- Diagnostic workup, including laboratory tests and imaging studies
- Differential diagnosis and identification of AKI etiologies
Takeaway
The article highlights the importance of a structured and timely diagnostic approach to AKI, incorporating biomarkers and advanced diagnostic tools to enhance early detection and management in critical care settings.
Renal replacement therapy (RRT)
Renal replacement therapy (RRT)
Renal replacement therapy in critical care
Lisa Gemmell et al., BJA Education (2017)
What’s inside
This article provides an overview of renal replacement therapy (RRT) in the context of critical care, discussing indications, modalities, and management strategies.
Why it’s relevant
RRT is a crucial intervention for managing acute kidney injury (AKI) and other renal dysfunctions in critically ill patients, and understanding its application is essential for optimizing patient care.
Key focus
- Indications for initiating RRT in critical care settings
- Different modalities of RRT, including intermittent hemodialysis, continuous renal replacement therapy (CRRT), and sustained low-efficiency dialysis (SLED)
- Management of anticoagulation during RRT
- Dose and prescription of RRT, including fluid and solute management
- Complications and considerations in special populations, such as patients with sepsis or multi-organ failure
Takeaway
The article emphasizes the importance of tailoring RRT to the individual needs of critically ill patients, considering the underlying pathophysiology and clinical context to improve outcomes.
Renal replacement therapy (RRT)
Nomenclature for renal replacement therapy in acute kidney injury: basic principles
Mauro Neri et al., Critical Care (2016)
What’s inside
This article presents a standardized nomenclature for renal replacement therapy (RRT) in the context of acute kidney injury (AKI), aiming to improve clarity and consistency in communication among healthcare professionals.
Why it’s relevant
A consistent nomenclature for RRT is essential for accurate documentation, research, and clinical practice, ensuring that all stakeholders have a common understanding of the therapies used in AKI management.
Key focus
- Definition and classification of RRT modalities, including intermittent and continuous therapies
- Standardized terminology for describing RRT techniques and their components
- Importance of clear communication in clinical settings and research
- Recommendations for adopting the proposed nomenclature in practice and literature
Takeaway
The article underscores the need for a unified language in RRT to enhance communication, education, and research, ultimately improving the care of patients with AKI.
Renal replacement therapy (RRT)
What a Clinician Should Know About a Renal Replacement Membrane?
Patrick M. Honore et al., Journal of Translational Internal Medicine (2018)
What’s inside
This article provides an in-depth overview of renal replacement membranes, focusing on their properties, types, and clinical implications for use in renal replacement therapy (RRT).
Why it’s relevant
Understanding the characteristics and functions of renal replacement membranes is crucial for clinicians to optimize RRT, ensuring effective treatment and minimizing complications in patients with acute kidney injury (AKI).
Key focus
- Types of membranes used in RRT, including their composition and structure
- Impact of membrane biocompatibility on patient outcomes
- Role of membrane permeability and clearance capabilities in solute removal
- Considerations for selecting appropriate membranes based on patient needs and clinical scenarios
- Potential complications and management strategies related to membrane use
Takeaway
The article emphasizes the importance of selecting the right membrane for RRT based on clinical context and patient-specific factors to enhance treatment efficacy and safety in critical care settings.
Drug dosing in renal replacement therapy
Antimicrobial drug dosing in renal replacement therapy
A Guide to Understanding Antimicrobial Drug Dosing in Critically Ill Patients on Renal Replacement Therapy
Valentina Pistolesi et al., Antimicrobial Agents and Chemotherapy (2019)
What’s inside
This article offers a comprehensive guide to antimicrobial drug dosing in critically ill patients undergoing renal replacement therapy (RRT), addressing the complexities and considerations necessary for effective treatment.
Why it’s relevant
Proper dosing of antimicrobial drugs is crucial in critically ill patients on RRT to ensure therapeutic efficacy while minimizing toxicity, given the altered pharmacokinetics in these patients.
Key focus
- Impact of RRT on antimicrobial pharmacokinetics and pharmacodynamics
- Strategies for optimizing antimicrobial dosing in patients receiving different RRT modalities
- Importance of therapeutic drug monitoring (TDM) in guiding dosage adjustments
- Recommendations for specific antimicrobial agents commonly used in critical care
- Considerations for special patient populations, such as those with sepsis or multi-organ failure
Takeaway
The article highlights the need for individualized antimicrobial dosing strategies in critically ill patients on RRT, emphasizing the role of TDM and careful consideration of RRT modalities to achieve optimal therapeutic outcomes.
Drug dosing in renal replacement therapy
The Renal Drug Handbook
Caroline Ashley et al., CRC Press (2019)
What’s inside
This handbook serves as a comprehensive reference for healthcare professionals, providing detailed information on the use of drugs in patients with kidney disease, including those undergoing renal replacement therapy (RRT).
Why it’s relevant
Proper drug dosing and management in patients with renal impairment are critical to ensure efficacy and safety, particularly in the context of altered pharmacokinetics due to kidney dysfunction.
Key focus
- Detailed drug monographs covering dosing adjustments for patients with varying degrees of renal function
- Guidance on drug selection and monitoring in patients with chronic kidney disease (CKD) and acute kidney injury (AKI)
- Information on drug interactions and potential nephrotoxic effects
- Practical advice on managing medications during different modalities of RRT
- Considerations for special populations, such as pediatric and elderly patients
Takeaway
The Renal Drug Handbook is an essential resource for clinicians, offering evidence-based guidance on drug therapy in renal patients to optimize treatment outcomes and minimize adverse effects.