Nomenclature for renal replacement therapy in acute kidney injury: basic principles

Abstract

This article reports the conclusions of a consensus expert conference on the basic principles and nomenclature of renal replacement therapy (RRT) currently utilized to manage acute kidney injury (AKI). This multidisciplinary consensus conference discusses common definitions, components, techniques, and operations of the machines and platforms used to deliver extracorporeal therapies, utilizing a “machine-centric” rather than a “patient-centric” approach. We provide a detailed description of the performance characteristics of membranes, filters, transmembrane transport of solutes and fluid, flows, and methods of measurement of delivered treatment, focusing on continuous renal replacement therapies (CRRT) which are utilized in the management of critically ill patients with AKI. This is a consensus report on nomenclature harmonization for principles of extracorporeal renal replacement therapies. Devices and operations are classified and defined in detail to serve as guidelines for future use of terminology in papers and research.

Removal of Procalcitonin and Selected Cytokines during Continuous Veno-Venous Hemodialysis Using High Cutoff Hemofilters in Patients with Sepsis and Acute Kidney Injury

“…Net ultrafiltration (Q UF NET – volume removed from the patient by the machine per unit of time) was 100 mL/h on average. For anticoagulatory support, the replacement flow rate in pre-dilution (Q R PRE ) was 250 mL/h [6]. Anticoagulation was performed using unfractionated heparin or, if severe coagulation disorders occurred, anticoagulation was performed only by flushing with 0.9% NaCl.…”

Biocompatibility and Cytotoxic Evaluation of New Sorbent Cartridges for Blood Hemoperfusion

“…The main purpose of such extracorporeal therapies is to remove specific toxins and solutes from the body. Mass removal is achieved by the use of dedicated devices made of biocompatible polymers and is governed by diffusion and adsorption [7]. This last term refers to the separation of solutes from a mixture by binding the specimen to a sorbent surface; typical condition for this mechanism is hemoperfusion (HP).…”

A Call to Action to Develop Integrated Curricula in Cardiorenal Medicine

“…Not only should the acid base and electrolyte be carefully managed, but also the fluid balance and blood pressure must be controlled in patients with AKI. In patients undergoing renal replacement therapy for severe oliguria and uremia, these tasks should be accomplished by different extracorporeal techniques whose prescription and delivery must be accurate and carefully executed using an accepted nomenclature [34]. The experience of the nephrologist is paramount in establishing the scope and goals of diuretic and extracorporeal therapy.…”