ISCCM Guidelines on Acute Kidney Injury and Renal Replacement Therapy

Abstract

Acute kidney injury (AKI) is a complex syndrome with a high incidence and considerable morbidity in critically ill patients. Renal replacement therapy (RRT) remains the mainstay of treatment for AKI. There are at present multiple disparities in uniform definition, diagnosis, and prevention of AKI and timing of initiation, mode, optimal dose, and discontinuation of RRT that need to be addressed. The Indian Society of Critical Care Medicine (ISCCM) AKI and RRT guidelines aim to address the clinical issues pertaining to AKI and practices to be followed for RRT, which will aid the clinicians in their day-to-day management of ICU patients with AKI. How to cite this article Mishra RC, Sodhi K, Prakash KC, Tyagi N, Chanchalani G, Annigeri RA, et al . ISCCM Guidelines on Acute Kidney Injury and Renal Replacement Therapy. Indian J Crit Care Med 2022;26(S2):S13–S42.

Further improvement of circuit survival in citrate based continuous renal replacement therapy

“…Collected data included: [ 1 ]. patient characteristics [age, sex at birth, admission diagnosis, the Acute Physiology and Chronic Health Evaluation score 4 (APACHE IV) score, presence of COVID-19 and chronic kidney disease (CKD), indication for CRRT, body length, and weight, type, and dose of anticoagulants], [ 2 ]. Daily laboratory data recorded were: hematocrit, PT, aPTT, fibrinogen, total calcium, albumin, phosphate, and magnesium levels, and multiple times per day point of care blood-gas analyses including measurements of pH, pCO 2 , HCO 3 − , chloride, lactate, iCa, sodium, and potassium, [ 3 ].…”

“…The primary outcome was CRRT circuit survival time in hours. For this primary outcome analysis, we excluded circuits that were terminated because of [ 1 ] diagnostic procedures or interventions (operations) outside the ICU [ 2 ], technical errors of the Prismax, and [ 3 ] circuits that were ended because of the decision to cease CRRT, since the survival time of these circuits does not reflect the performance of the CRRT protocols.…”

“…Secondary outcomes were: [ 1 ] delivered CRRT dose expressed as mean delivered effluent dose in ml/kg/hour during the full CRRT treatment duration [ 2 ]; proportion of patients who developed: (i) a clinically relevant metabolic alkalosis, defined as pH > 7.45 and HCO 3 − >28 mmol/l; (ii) non-lactate high anion gap metabolic acidosis [(Na–Cl–HCO 3 − –lactate) + 0.25 (40–serum albumin)] >12 mmol/l); (iii) increased total Ca/iCa ratio (>2.25); (iv) hypophosphatemia (<0.7 mmol/l); and (v) sodium derangements (Na < 135 and >145 mmol/l) [ 3 ] and recovery of metabolic acidosis (pH ≥ 7.38 and HCO 3 − ≥22) [ 5 ]. For these analyses, we included only patients who underwent complete per protocol treatment.…”

“…Continuous renal replacement therapy (CRRT) is the most frequently used modality of renal replacement therapy (RRT) in critical care patients with acute kidney injury (AKI) [ 1 ]. The debate regarding CRRT dose prescription in patients with AKI has been settled with guidelines advising a dose of 20-25 ml/kg/h [ 2 , 3 ]. The actual delivery of this dose, however, can be challenging due to clotting in the CRRT circuit.…”

Is SLED Efficient in Sepsis Associated Acute Kidney Injury: Hope but Hold!!

“…Though there are specific preferences for the mode of Renal replacement therapy, CRRT is recommended in patients with acute brain injury or increased intracranial tension as per ISCCM guidelines. 7 …”