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Highly Accessed Review

Clinical review: Timing of renal replacement therapy

Michael Joannidis1* and Lui G Forni2

Author Affiliations

1 Medical Intensive Care Unit, Department of General Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria

2 Department of Critical Care, Western Sussex Hospitals Trust, Honorary Senior Lecturer, Brighton and Sussex Medical Schools, University of Sussex, Falmer, Brighton BN1 9PX, UK

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Critical Care 2011, 15:223  doi:10.1186/cc10109

Published: 10 June 2011

Abstract

Acute kidney injury is common in intensive care patients and continuous renal replacement therapy is the preferred treatment for this in most centres. Although these techniques have been adopted internationally, there remains significant variation with regard to their clinical application. This is particularly pertinent when one considers that the fundamental questions regarding any treatment, such as initiation, dose and length of treatment, remain a source of debate and have not as yet all been fully answered. In this narrative review we consider the timing of renal replacement therapy, highlighting the relative paucity of high quality data regarding this fundamental question. We examine the role of the usual biochemical criteria as well as conventional clinical indications for commencing renal replacement therapy together with the application of recent classification systems, namely RIFLE and AKIN. We discuss the potential role of biomarkers for acute kidney injury as predictors for the need for renal support and discuss commencing therapy for indications other than acute kidney injury.