TY - CHAP M1 - Book, Section TI - Renal Replacement Therapy A1 - Coritsidis, George A1 - Bhatti, Saad A2 - Oropello, John M. A2 - Pastores, Stephen M. A2 - Kvetan, Vladimir PY - 1 T2 - Critical Care AB - KEY POINTSRenal replacement therapy (RRT) is one of the most expensive interventions used in an already cost burdensome intensive care unit (ICU) setting. Prescribing RRT in the critically ill is complex and ideally should involve clear communication between nephrologist and intensivist.RRT modalities include peritoneal dialysis, intermittent hemodialysis, continuous renal replacement therapies, and sustained low-efficiency daily dialysis.These modalities utilize 2 transport mechanisms in providing renal replacement: diffusion and convection. These forces result in solute clearance and plasma water removal or ultrafiltration (UF).RRT is initiated early in patients whose renal function is not expected to quickly improve due to severity of illness and is unresponsive to resuscitation: multiorgan failure, high fractional excretion of sodium (FENa), rising azotemia (without plateau of urea or creatinine levels), and oliguria all suggestive of acute tubular necrosis (ATN).At present, randomized trials and meta-analyses, do not support a mortality benefit for one modality over another. However, a gradual clearance rate may be wise in hemodynamic instability, acute coronary syndromes, elevated intracranial pressures (ICPs), or hypo/hypernatremia. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessmedicine.mhmedical.com/content.aspx?aid=1136414759 ER -