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Permissive hypofiltration

Lakhmir S Chawla12*, John A Kellum34 and Claudio Ronco5

Author Affiliations

1 Department of Anesthesiology and Critical Care Medicine, George Washington University Medical Center, 900 23rd Street, NW, RILF, Room G-105, Washington, DC 20037, USA

2 Department of Medicine, Division of Renal Diseases and Hypertension, George Washington University Medical Center, Washington DC 20037, USA

3 Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA

4 CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, 603B Scaife Hall Pittsburgh, PA 15261, USA

5 Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Viale Rodolfi, 37, 36100 Vicenza, Italy

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Critical Care 2012, 16:317  doi:10.1186/cc11253

Published: 26 July 2012

Abstract

Acute kidney injury (AKI) is a syndrome with a multitude of causes and is associated with high mortality and a permanent loss of renal function. Our current understanding of the most common causes of AKI is limited, and thus a silver bullet therapy remains elusive. A change in the approach to AKI that shifts away from the primary composite endpoint of death/dialysis, and instead focuses on improving survival and mitigating permanent renal damage, is likely to be more fruitful. We suggest that the current approach of augmenting renal function by increasing the renal blood flow or glomerular filtration rate during AKI may actually worsen outcomes. Analogous to the approach towards adult respiratory distress syndrome that limits ventilator-induced lung injury, we propose the concept of permissive hypofiltration. The primary goals of this approach are: resting the kidney by providing early renal replacement therapy, avoiding the potentially injurious adverse events that occur during AKI (for example, fluid overload, hypophosphatemia, hypothermia, and so forth), and initiating therapies focused on improving survival and mitigating permanent loss of kidney function.