Reviews cover a clinical, translational, or basic science topic of interest to practitioners and describe the treatment, diagnosis, or pathogenesis of a disease process or its complications, emphasizing recent advances in the field.
- The optimal timing of kidney support therapy in critically ill patients with acute kidney injury (AKI) without life-threatening complications related to AKI is controversial. Recent multicenter, randomized, controlled studies have questioned the need for earlier initiation of therapy, despite one study showing a benefit in survival and others with no differences in mortality based on the timing of kidney support therapy initiation. These findings reflect the uncertainties in decisions to initiate kidney support therapy, which should ideally be individualized according to the patient’s comorbidities, severity of illness, trajectory of kidney function, and urine output as well as requirements for fluid balance and solute removal.
- Prescribing dialysis to manage acute kidney injury (AKI) is common and recently has become a controversial area for physicians. The concept of dialysis “dose” initially was developed for end-stage renal disease and has been extended to AKI in the last decade. Urea kinetic modeling has been the mainstay of dose quantification in end-stage renal disease. Extrapolation of these techniques to critically ill patients with AKI is difficult because of a non–steady state leading to a variable increase in urea generation rate, alterations in total-body water and its compartmental distribution, and changing renal excretory capacity.