How to Choose the Ideal Renal Replacement Therapy in Sepsis?

Abstract

Sepsis is the main cause of acute kidney injury (AKI) among individuals hospitalized in intensive care units. Acute kidney injury is an independent risk factor for mortality, and its occurrence increases the complexity and cost of treatment. However, the pathophysiological mechanisms of AKI remain unclear. Hemodynamic, vascular, tubular, cellular, inflammatory, and oxidative processes are involved. Individuals with AKI generally have various comorbidities and are elderly and hypercatabolic and on vasopressors and mechanical ventilation. Dialysis is the main treatment for AKI. Although there is no clear benefit of any specific dialysis modality, these patients are initially instructed to use continuous dialysis methods, especially for the most severe cases with multiple organ system dysfunctions and for those who display signs of hemodynamic instability. Recent studies demonstrate that patients should receive a dialysis dose of at least 25 mL · kg · h.

Impact of plasma histones in human sepsis and their contribution to cellular injury and inflammation

“…A hallmark of sepsis is the occurrence of renal failure requiring renal replacement therapy [ 17 ]. Consistently, our data suggested that higher levels of histones correlated with the need for RRT.…”

Mesenchymal Stem Cells Ameliorate Sepsis-associated Acute Kidney Injury in Mice

“…Sepsis is the most common cause of death in the intensive care unit, and sepsis-associated acute kidney injury (SA-AKI) is an independent risk factor for mortality. Its occurrence increases the complexity and costs of treatment (2). Currently, there are no effective methods to treat or prevent SA-AKI.…”

Online Hemodiafiltration Compared to Conventional Hemodialysis in Critically Ill Patients

“…Severe acute kidney injury (AKI) in critically ill patients requiring renal replacement therapy (RRT) has a poor prognosis 1,2 , with short-term mortality up to 60% when there is multiple organ dysfunction [3][4][5][6] . Survivors may develop kidney scarring, including tubular atrophy and interstitial fibrosis, which can lead to chronic kidney disease (CKD) 7 .…”

“…While continuous RRT (CRRT) is generally preferred in patient with hemodynamic instability 3,9 , intermittent (IRRT) is generally deployed in survivors after stabilisation. Conventional hemodialysis (HD) provides clearance of small solutes mainly via a diffusion process but has a limited efficiency in removing larger molecules like cytokines 10 .…”