The optimal dose of renal replacement therapy in acute kidney injury

Abstract

Acute kidney injury (AKI) is one of the most serious conditions among hospitalized patients, particularly for critically ill patients in the intensive care unit. Despite significant advances in dialysis technology, the mortality in patients with AKI severe enough to require renal replacement therapy (RRT) remains unacceptably high. Several single center studies have revealed that high intensity CRRT is associated with improved mortality. Since then, it has been thought that intensive CRRT should be desirable for patients with AKI. However, two large multicenter randomized controlled trials have shown that higher doses of continuous RRT (CRRT) for AKI do not lead to improved survival. On the other hand, in Japan, patients with AKI usually receive lower doses of CRRT. To date, studies have not verified whether significant differences in survival result from the CRRT dose used in Japan versus the international standard dose. We discuss the optimal intensity of CRRT in critically ill patients with AKI.